Individual
JENNIFER L. COUNCELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1473 E STATE ROAD 44, WHITEWATER VALLEY PRIMARY CARE, CONNERSVILLE, IN 47331-8374
(765) 825-8446
(765) 827-0013
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 825-8446
(765) 827-0013
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005873A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000965537
ANTHEM (REID PHYSICIAN ASSOCIATES, INC.)
—
05
—
0150521
—
OH
05
—
201325910
—
IN
Enumeration date
10/14/2015
Last updated
05/13/2021
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