Healthcare Provider Details

I. General information

NPI: 1841514882
Provider Name (Legal Business Name): JILL KOCHER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 11/27/2023
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 CLEARVISTA DR STE 5100
INDIANAPOLIS IN
46256-1868
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-9655
  • Fax: 317-621-3099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number28163865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: