Healthcare Provider Details

I. General information

NPI: 1083216329
Provider Name (Legal Business Name): COURTNEY JANINE JAMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY JANINE MCCLENDON

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-7208
  • Fax: 317-944-5791
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28237533A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71011628A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: