Healthcare Provider Details

I. General information

NPI: 1245846997
Provider Name (Legal Business Name): JESSICA LIMBURG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 CHESTER BLVD
RICHMOND IN
47374-1947
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICE
RICHMODN IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-1600
  • Fax: 765-962-9641
Mailing address:
  • Phone: 765-935-5331
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010335A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: