Individual provider Active NPI

Jacqueline Fitzgerald

  • Family Nurse Practitioner
  • West Lafayette, IN
National Provider Identifier
1891501367
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71016397A Issued in IN
Practice address
909 Sagamore Pkwy W
West Lafayette, IN 47906-1443
Phone
(765) 463-6262
Fax
(765) 463-9122
NPI assigned
Dec 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71016397A IN Primary

Addresses

Primary practice location

909 Sagamore Pkwy W
West Lafayette, IN 47906-1443

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Other practice location 1

3218 Daugherty Dr
Lafayette, IN 47909-3997
Phone (765) 607-0958

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250416003025 IN Practitioner - Nurse Practitioner 8426573080 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince May 1, 2025 Accepting new patients
Franciscan Physician Network CurrentSince May 1, 2025 Accepting new patients
Franciscan Physician Network Current Accepting new patients

Locations

308 W Market St
Crawfordsvlle, IN 47933
Phone (765) 359-1660

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

909 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 463-6262

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1891501367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061443",
            "telephone_number": "765-463-6262",
            "fax_number": "765-463-9122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3218 Daugherty Dr",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479093997",
            "country_code": "US",
            "telephone_number": "765-607-0958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71016397A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Lafayette, IN

Sources for this page

Verify at the official NPI Registry.