Active NPI
Kelly Anne Jayne, PA-C
- Physician Assistant
- Berwick, PA
National Provider Identifier
1992177604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1016 W Front St
Berwick, PA 18603-4525 - Phone
- (708) 290-0031
- Fax
- (570) 802-0104
- NPI assigned
- Oct 21, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1016 W Front St
Berwick, PA 18603-4525
Mailing address
1016 W Front St
Berwick, PA 18603-4525
Phone (570) 802-0102
Other practice location 1
2440 M St NW Ste 313
Washington, DC 20037
Phone (202) 775-1792
Other practice location 2
3833 Fairfax Dr Ste 360
Arlington, VA 22203-1774
Phone (571) 363-4791
Other names 1
- Kelly Jayne
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dermdox WB PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dermatology Physician
- Wilkes Barre, PA
- NPI 1497550123
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653091200000",
"number": "1992177604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 W FRONT ST",
"city": "BERWICK",
"state": "PA",
"postal_code": "186034525",
"telephone_number": "570-802-0102",
"fax_number": "570-802-0104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 W FRONT ST",
"city": "BERWICK",
"state": "PA",
"postal_code": "186034525",
"telephone_number": "708-290-0031",
"fax_number": "570-802-0104"
}
],
"practiceLocations": [
{
"address_1": "2440 M St NW Ste 313",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "20037",
"country_code": "US",
"telephone_number": "202-775-1792",
"fax_number": "202-775-0494",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3833 Fairfax Dr Ste 360",
"address_purpose": "LOCATION",
"city": "Arlington",
"state": "VA",
"postal_code": "222031774",
"country_code": "US",
"telephone_number": "571-363-4791",
"fax_number": "571-363-4792",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JAYNE",
"first_name": "KELLY",
"middle_name": "ANNE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-21",
"last_updated": "2022-05-21",
"certification_date": "2022-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "JAYNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Berwick, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.