MEDICARE: DR. JENNIFER ANN CODDINGTON DNP, MSN, RN, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	71000722A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9397700	OTHER	IN	PHCS PID NUMBER
3	000000351155	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1346209392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ANN CODDINGTON DNP, MSN, RN, CPNP

Provider Business Mailing Address
First Line	:	502 N UNIVERSITY ST
Second Line	:	JOHNSON HALL RM B-5
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2069
Country	:	US
Telephone Number	:	765-494-6341
Fax Number	:	765-496-1022

Provider Business Practice Location Address
First Line	:	502 N UNIVERSITY ST
Second Line	:	JOHNSON HALL RM B-5
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2069
Country	:	US
Telephone Number	:	765-494-6341
Fax Number	:	765-496-1022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	08/06/2009

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