Provider Demographics
NPI:1881557569
Name:BACH, JAMIE KAYE (MSN, SCRN, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:KAYE
Last Name:BACH
Suffix:
Gender:F
Credentials:MSN, SCRN, ACNPC-AG
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KAYE
Other - Last Name:KROUPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, SCRN, ACNPC-AG
Mailing Address - Street 1:4900 BROAD RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2265
Mailing Address - Country:US
Mailing Address - Phone:402-960-1970
Mailing Address - Fax:
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF312614363LA2100X, 363LA2200X, 363LG0600X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology