Healthcare Provider Details

I. General information

NPI: 1497667067
Provider Name (Legal Business Name): OPEN PHASE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST
BEECH GROVE IN
46107-1835
US

IV. Provider business mailing address

301 MAIN ST
BEECH GROVE IN
46107-1835
US

V. Phone/Fax

Practice location:
  • Phone: 317-680-2568
  • Fax: 317-680-2592
Mailing address:
  • Phone: 317-680-2568
  • Fax: 317-680-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACIE AUNDREA JONES
Title or Position: OWNER/MANAGING MEMBER
Credential: DNP, FNP-C, PMHNP-BC
Phone: 317-680-2568