Healthcare Provider Details

I. General information

NPI: 1548770290
Provider Name (Legal Business Name): JENNAY NEELEY JONES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNAY NEELEY LESLEY RN

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RANDALLIA DR
FORT WAYNE IN
46805-4638
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-6070
  • Fax: 260-373-6704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71007680A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: