Individual
JESSICA JO BRANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
705 RILEY HOSPITAL DR, RR 208, INDIANAPOLIS, IN 46202-5109
(317) 274-4715
(317) 274-2065
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28178610A
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71009236A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M22404229
MEDICARE PTAN
IN
Enumeration date
06/12/2019
Last updated
08/23/2023
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