Healthcare Provider Details

I. General information

NPI: 1942811088
Provider Name (Legal Business Name): JOHN CHRISTIAN FYFFE MSN, RN, FNP, RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MARKET ST
CHARLESTOWN IN
47111-9535
US

IV. Provider business mailing address

2100 MARKET ST
CHARLESTOWN IN
47111-9535
US

V. Phone/Fax

Practice location:
  • Phone: 812-503-5100
  • Fax:
Mailing address:
  • Phone: 812-503-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number71010409A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28231030A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28231030A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: