Individual
BOBBIE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3125 S SCATTERFIELD RD STE 300, ANDERSON, IN 46013-1803
(765) 298-4311
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005471A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201289090
—
IN
01
—
28142824A
RN IN LICENSE
IN
01
—
71005471A
INDIANA APN LICENSE
IN
01
—
P01512390
RR MEDICARE
IN
Enumeration date
03/09/2015
Last updated
11/27/2023
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