Healthcare Provider Details

I. General information

NPI: 1326942319
Provider Name (Legal Business Name): JESYLAN BEDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CROSSING BLVD
TERRE HAUTE IN
47802-5316
US

IV. Provider business mailing address

3429 W CENTER RD
SULLIVAN IN
47882-7230
US

V. Phone/Fax

Practice location:
  • Phone: 812-798-3287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28281831A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: