Individual
JEAN ELLEN KOLP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002651A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000997789
ANTHEM PROVIDER NUMBER
IN
05
—
200904210
—
IN
Enumeration date
05/29/2008
Last updated
03/15/2021
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