MEDICARE: PEDIATRIC NURSING SPECIALISTS OF INDIANA, INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700877354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC NURSING SPECIALISTS OF INDIANA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 16809
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39404-6809
Country	:	US
Telephone Number	:	601-268-1842
Fax Number	:	601-268-7898

Provider Business Practice Location Address
First Line	:	3500 DEPAUW BLVD
Second Line	:	SUITE 1041
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1170
Country	:	US
Telephone Number	:	317-875-6825
Fax Number	:	317-802-2259

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	MISS NANCY C JAKUS
Credential	:	RN BSN MBA
Telephone Number	:	601-268-1842

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/22/2020

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