Individual provider Active NPI

Jakie Lynn Conachan

  • Psychiatric/Mental Health Nurse Practitioner
  • Bay City, MI
National Provider Identifier
1942844568
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704235146 Issued in MI
Practice address
690 S Trumbull St
Bay City, MI 48708-7692
Phone
(989) 922-5700
Fax
(989) 771-7050
NPI assigned
Nov 6, 2019
Last updated
Feb 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704235146 MI Primary

Addresses

Primary practice location

690 S Trumbull St
Bay City, MI 48708-7692

Mailing address

4300 Castle Dr
Midland, MI 48640-3490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20200311002367 MI Practitioner - Nurse Practitioner 0941638662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

4136 Legacy Pkwy
Lansing, MI 48911-4265
Phone (517) 882-3732

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Downriver Mental Health Clinic PC CurrentSince Nov 17, 2024 Accepting new patients
Downriver Mental Health Clinic PC CurrentSince Nov 17, 2024 Accepting new patients
Great Lakes Bay Health Centers CurrentSince Apr 5, 2021 Accepting new patients
Great Lakes Bay Health Centers CurrentSince Apr 5, 2021 Accepting new patients

Locations

690 S Trumbull St
Bay City, MI 48708
Phone (989) 922-4900

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

3475 Belle Chase Way
Lansing, MI 48911
Phone (517) 303-8044

4136 Legacy Pkwy
Lansing, MI 48911
Phone (517) 492-0517

501 Lapeer Ave
#R
Saginaw, MI 48607
Phone (989) 753-6000

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.jakieconachan@150339.advancedmd-direct.com

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1942844568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CASTLE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486403490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S TRUMBULL ST",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487087692",
            "telephone_number": "989-922-5700",
            "fax_number": "989-771-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONACHAN",
        "first_name": "JAKIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-06",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704235146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay City, MI

Sources for this page

Verify at the official NPI Registry.