1598161010 NPI number — JANET E. KERCHER NP

Table of content: JANET E. KERCHER NP (NPI 1598161010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598161010 NPI number — JANET E. KERCHER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERCHER
Provider First Name:
JANET
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOOLEY
Provider Other First Name:
JANET
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598161010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3245 HEALTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-647-1840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 W WARREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46540-9410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-825-2146
Provider Business Practice Location Address Fax Number:
574-524-7435
Provider Enumeration Date:
11/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  71005226A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201267810 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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