Individual
JEPARIS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10411 N COLLEGE AVE, INDIANAPOLIS, IN 46280-1436
(317) 688-7748
Mailing address
10411 N COLLEGE AVE, INDIANAPOLIS, IN 46280-1436
(317) 688-7748
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
17-014066-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300008106
—
IN
Enumeration date
11/17/2017
Last updated
11/17/2017
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