Healthcare Provider Details

I. General information

NPI: 1104487370
Provider Name (Legal Business Name): RONIN ST JAMES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES SHEARON

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N SENATE AVE STE 100
INDIANAPOLIS IN
46202-3297
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-0166
  • Fax: 317-963-2711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009060A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: