MEDICARE: JADEN KEENAN LEBLANC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942136544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADEN KEENAN LEBLANC

Provider Business Mailing Address
First Line	:	2152 PENNY LN APT 202
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 UNIVERSITY BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5147
Country	:	US
Telephone Number	:	317-274-4591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ JADEN KEENAN LEBLANC ” Practice Location

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