Healthcare Provider Details

I. General information

NPI: 1740834241
Provider Name (Legal Business Name): JESSICA GERNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BESAW

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MAIN ST STE 209Q
CROWN POINT IN
46307-4469
US

IV. Provider business mailing address

123 N MAIN ST STE 209Q
CROWN POINT IN
46307-4469
US

V. Phone/Fax

Practice location:
  • Phone: 219-243-2098
  • Fax: 855-731-1972
Mailing address:
  • Phone: 219-243-2098
  • Fax: 855-731-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009197A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: