Healthcare Provider Details

I. General information

NPI: 1588217657
Provider Name (Legal Business Name): CELESTE AMANDA JONES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VAN NUYS RD
NEW CASTLE IN
47362-9060
US

IV. Provider business mailing address

PO BOX 271
LEWISVILLE IN
47352-0271
US

V. Phone/Fax

Practice location:
  • Phone: 765-593-0111
  • Fax:
Mailing address:
  • Phone: 765-591-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28174151A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: