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General NPI Number Information
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NPI Number | 1548111503
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Entity Type | Organization
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Legal Business Name | OLD TOWN MEDICAL CLINIC
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 475 SHERIDAN RD
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City | NOBLESVILLE
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State | IN
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Zip | 46060-1315
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Country | US
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Telephone | 317-315-4554
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Fax | 317-863-5046
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Provider Business Mailing Address
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Address Line | 475 SHERIDAN RD
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City | NOBLESVILLE
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State | IN
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Zip | 46060-1315
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Country | US
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Telephone | 317-315-4554
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Fax | 317-863-5046
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Authorized Official
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Title or Position | OWNER/PROVIDER/MEDICAL DIRECTOR
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Name | CASSIDY JAYNE MCKINLEY
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Credential | AGACNP-BC
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Telephone | 317-315-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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