Healthcare Provider Details

I. General information

NPI: 1750382446
Provider Name (Legal Business Name): JEFFERY HOWARD BARON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 SYMMES CENTER DR STE 1
WINCHESTER IN
47394-9402
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-586-6600
  • Fax: 765-547-6503
Mailing address:
  • Phone: 765-983-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000348A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: