Healthcare Provider Details

I. General information

NPI: 1316185861
Provider Name (Legal Business Name): JESSICA A COLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 11/27/2023
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 E 10TH ST SUITE 230
INDIANAPOLIS IN
46229-2664
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-9220
  • Fax: 317-355-9230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number71002872A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: