MEDICARE: JAIME ALLISON BRISTOW NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	28202301A	IN

General Provider Information

NPI Number	:	1598250797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME ALLISON BRISTOW NP

Provider Business Mailing Address
First Line	:	495 FLATBUSH AVE STE C5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3706
Country	:	US
Telephone Number	:	800-336-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 KESSLER BOULEVARD EAST DR STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2889
Country	:	US
Telephone Number	:	800-336-1100
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	05/16/2023

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