JACQULYN BURGESS


Address: 1500 Salem St, Lafayette, IN 47904-2164
Phone: 7654488000

JACQULYN BURGESS (NPI# 1801246467) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1801246467
Entity Type Individual
Full Name JACQULYN BURGESS
Credential RN
Practice Address 1500 Salem St
Lafayette
IN 47904-2164
Mailing Address Po Box 5545
Lafayette
IN 47903-5545
Practice Telephone 7654488000
Mailing Telephone 7654488000
Enumeration Date 2016-06-15
Last Update Date 2017-02-01
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163W00000X Registered Nurse 28190531A IN Nursing Service Providers
Y 363L00000X Nurse Practitioner 71006463A IN Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
IN ANTHEM PROVIDER NUMBER 000001044600 01
IN 201384020 05

Office Location

Street Address 1500 SALEM ST
City LAFAYETTE
State IN
Zip Code 47904-2164

Providers in the same location

NPI Name Taxonomy Address Enumeration
1568448876 Tamara Loewen Hazbun Emergency Medicine 1500 Salem St, Lafayette, IN 47904-2164 2005-12-19
1942656186 Amanda Dehne Registered Nurse 1500 Salem St, Lafayette, IN 47904-2164 2016-05-06
1134527807 Rebecca J Hauck Registered Nurse 1500 Salem St, Lafayette, IN 47904-2164 2014-12-12
1679977128 Michael E Criswell Clinical Nurse Specialist 1500 Salem St, Lafayette, IN 47904-2164 2014-10-13
1962840785 Amy Sue Mclaughlin Registered Nurse 1500 Salem St, Lafayette, IN 47904-2164 2013-06-14
1487920310 Laurie L Lebegue Specialist/Technologist, Other 1500 Salem St, Lafayette, IN 47904-2164 2012-03-26
1356659403 Leslie Anne Bentinganan Family Medicine 1500 Salem St, Lafayette, IN 47904-2164 2010-09-22
1154598563 Tasbirul Islam Internal Medicine 1500 Salem St, Lafayette, IN 47904-2164 2008-05-14
1346413713 Leslie E Harshman Specialist/Technologist, Other 1500 Salem St, Lafayette, IN 47904-2164 2008-04-08
1376715631 Teri Anne Anderson Specialist/Technologist, Other 1500 Salem St, Lafayette, IN 47904-2164 2008-03-27
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1568998615 Angela Hands Physical Therapy Assistant 1260 North 17th Street, Lafayette, IN 47904 2017-05-11
1366894164 Kathryn Barnett Behavioral Analyst 2785 Cason St # 2, Lafayette, IN 47904 2016-07-06
1881972917 Rest Assured, LLC Durable Medical Equipment & Medical Supplies 180 Professional Ct., Lafayette, IN 47904 2011-07-22
1144514233 Michelle Cristin Singleton Dietitian, Registered 508 N 26th St, Lafayette, IN 47904 2011-06-06
1912134438 Jean D Trammel Marriage & Family Therapist 2000 Greenburg St, Bldg B, Suite A, Lafayette, IN 47904 2009-06-11
1902946056 Terry Richard Baker Optometrist 2300 Sagamore Parkway S, Lafayette, IN 47904 2007-02-07
1891862165 Becki A Bowditch Inc Social Worker 2201 Ferry Street, Lafayette, IN 47904 2006-11-29
1326121849 James Lowell Thomas Pediatrics 2300 Ferry St, Lafayette, IN 47904 2006-10-21
1700976719 Michael Leonard Bagnoli Dentist 2020 Union Street, Suite 200, Lafayette, IN 47904 2006-10-13
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Taxonomy Information

Taxonomy Code 363L00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner

Taxonomy Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1487264594 Neely Primary Nurse Practitioner 102 Independence Blvd, Lafayette, LA 70506-6085 2020-08-04
1215553359 Sync Health LLC Nurse Practitioner 1300 Verot School Rd Ste D, Lafayette, LA 70508-5855 2020-06-24
1801422654 Lindsay Spurgeon Nurse Practitioner 892 Belgian Ln, Lafayette, IN 47905-0794 2020-03-12
1033754692 Harmony White Nurse Practitioner 1345 Unity Pl Ste 210, Lafayette, IN 47905-5762 2019-11-07
1962050591 Stephanie Ching Wong Nurse Practitioner 1735 S Public Rd Ste 203, Lafayette, CO 80026-7093 2019-08-27
1407353543 Dnprovider LLC Nurse Practitioner 312 Dunvegan Ct, Lafayette, LA 70503-6084 2018-04-06
1477065381 Amber R Wattigny Nurse Practitioner 155 Hospital Dr Ste 100, Lafayette, LA 70503-2852 2017-11-01
1346765617 Kristina Lynn Renfrow Nurse Practitioner 1345 Unity Pl Ste 310, Lafayette, IN 47905-5769 2017-08-08
1578086484 Melissa Ann Donahue Nurse Practitioner 3900 St Francis Way Ste 220, Lafayette, IN 47905-4925 2017-07-23
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City LAFAYETTE
Zip Code 47904

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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