Healthcare Provider Details

I. General information

NPI: 1902624844
Provider Name (Legal Business Name): CHANICE JOHNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

5519 BLACK CHERRY CIR
INDIANAPOLIS IN
46237-3806
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-2331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015817A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015817A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: