Healthcare Provider Details

I. General information

NPI: 1871068940
Provider Name (Legal Business Name): JALYN N DEERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JALYN N SHEARER NP

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 109TH AVE
CROWN POINT IN
46307-7294
US

IV. Provider business mailing address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-1444
  • Fax: 219-921-5303
Mailing address:
  • Phone: 219-921-1444
  • Fax: 219-921-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71008550A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number28245943A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: