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General NPI Number Information
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NPI Number | 1851284467
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Entity Type | Individual
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Provider Name | JESSICA RAE VAN HOORDE NP
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Gender | Female
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 820 N SAMUEL MOORE PKWY
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City | MOORESVILLE
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State | IN
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Zip | 46158-1467
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Country | US
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Telephone | 317-483-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 320 SHERWOOD DR
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City | MOORESVILLE
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State | IN
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Zip | 46158-1906
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Country | US
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Telephone | 812-272-9287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71016794A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F05250778
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License Number State | IN
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