Healthcare Provider Details

I. General information

NPI: 1740053677
Provider Name (Legal Business Name): KATIE JO JENKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W MAIN ST
AUSTIN IN
47102-1303
US

IV. Provider business mailing address

203 E MAIN ST
RICHMOND IN
47374-4208
US

V. Phone/Fax

Practice location:
  • Phone: 812-794-8100
  • Fax:
Mailing address:
  • Phone: 765-973-9294
  • Fax: 765-973-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014573A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: