Active NPI
Kaitlyn Thiessen
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1952906901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS61129
- Practice address
- 4280 Southside Blvd
Jacksonville, FL 32216-5400 - Phone
- (904) 998-3677
- NPI assigned
- Nov 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS61129 | FL | Primary |
Addresses
Primary practice location
4280 Southside Blvd
Jacksonville, FL 32216-5400
Mailing address
8681 A C Skinner Pkwy Apt 109
Jacksonville, FL 32256-0840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS61129 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1952906901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8681 A C SKINNER PKWY APT 109",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4280 SOUTHSIDE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322165400",
"telephone_number": "904-998-3677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIESSEN",
"first_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS61129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.