1. Home
  2. Directory
  3. Pennsylvania
  4. Wilkes Barre
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

JEFFERSON WATERS
NPI 1003756289
Student in an Organized Health Care Education/Training Program in Wilkes Barre, PA

Active since March 30, 2026PECOS Enrolled
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711(570) 808-7300 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jefferson Waters NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFERSON WATERS (NPI 1003756289) is an individual student in an organized health care education/training program in Wilkes Barre, Pennsylvania and active in the NPI registry since March 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003756289
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJEFFERSON WATERS
Location Address1000 E MOUNTAIN BLVDWilkes Barre, PA 18711-0027
Mailing Address1000 E Mountain BlvdWilkes Barre, PA 18711-0001
Phone(570) 808-7300
Sole ProprietorNo
Enumeration DateMarch 30, 2026
NPPES CertifiedMarch 30, 2026
✔ NPI 1003756289 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1000 E MOUNTAIN BLVD, Wilkes Barre, PA 18711
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jefferson Waters is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEVIN P BURKHARDT
Audiologist
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-7923
EVA VAISHNAV DO
Internal Medicine (Cardiovascular Disease)
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-6020
DR. WALTER MIECZKOWSKI III
Pharmacist
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-7300
SARAH EILEEN HELWIG CRNP
Nurse Practitioner
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-2338
STACY KANDRAC
Pharmacist
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-7701
VANESSA ANNE MARKLE PHARMACIST
Pharmacist
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-7754
DR. RICHARD M. SOMMA M.D.
Psychiatry & Neurology (Neurology)
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 820-6028
BONNIE TONG YOUNG ACNP
Nurse Practitioner (Acute Care)
1000 E MOUNTAIN BLVD
WILKES BARRE, PA 18711
Luzerne County (570) 808-6020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jefferson Waters's NPI number?

The NPI number for Jefferson Waters is 1003756289. It was assigned to this individual provider in the NPPES registry on March 30, 2026.

Where is Jefferson Waters located?

Jefferson Waters practices at 1000 E Mountain Blvd, Wilkes Barre, PA 18711. The listed phone number is (570) 808-7300.

What is Jefferson Waters's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jefferson Waters enrolled in Medicare?

Yes. Jefferson Waters is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jefferson Waters was last updated on March 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.