1649933656 NPI number — JO ANNA FRANCES CURLESS WHNP, IBCLC

Table of content: JO ANNA FRANCES CURLESS WHNP, IBCLC (NPI 1649933656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649933656 NPI number — JO ANNA FRANCES CURLESS WHNP, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURLESS
Provider First Name:
JO ANNA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP, IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIVERGOOD
Provider Other First Name:
JO ANNA
Provider Other Middle Name:
FRANCES
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:
1649933656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BEACON MEDICAL GROUP, INC
Provider Second Line Business Mailing Address:
3245 HEALTH DRIVE STE 100
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-647-3437
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 NAVARRE PL STE 4470
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-647-1405
Provider Business Practice Location Address Fax Number:
574-647-3970
Provider Enumeration Date:
10/17/2021

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: 363LW0102X , with the licence number:  71015319A , 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: 300094996 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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