Healthcare Provider Details

I. General information

NPI: 1881557569
Provider Name (Legal Business Name): JAMIE KAYE BACH MSN, SCRN, ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE KAYE KROUPA MSN, SCRN, ACNPC-AG

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5011
  • Fax:
Mailing address:
  • Phone: 402-960-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF312614
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312614
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF312614
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberF312614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: