Individual
JESSICA D TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1633 N CAPITOL AVE, STE 322, INDIANAPOLIS, IN 46202-1476
(317) 962-2929
(317) 962-2070
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28160961A
IN
363L00000X
Nurse Practitioner
71002942A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71002942A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200942620
—
IN
Enumeration date
05/12/2009
Last updated
02/14/2014
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