Individual
JESSICA MARIE TEMPLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-3242
(765) 281-6567
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10001195A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000704990
ANTHEM BC/BS
IN
01
—
P00910749
RAILROAD MEDICARE
IN
Enumeration date
02/05/2011
Last updated
04/28/2015
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