Healthcare Provider Details

I. General information

NPI: 1881972784
Provider Name (Legal Business Name): JESSICA RUTH TAULMAN-YOUNG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 W 71ST ST STE A
INDIANAPOLIS IN
46278-1705
US

IV. Provider business mailing address

PO BOX 330
FORTVILLE IN
46040-0330
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-3240
  • Fax: 317-920-3243
Mailing address:
  • Phone: 317-863-2556
  • Fax: 317-203-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001159A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07001159A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001159A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: