Provider Demographics
NPI:1063503134
Name:SPRINGMAN, JOHNNIE K (FNP)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:K
Last Name:SPRINGMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOHNNIE
Other - Middle Name:K
Other - Last Name:REED SPRINGMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-1886
Mailing Address - Fax:317-957-2891
Practice Address - Street 1:8931 E 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1501
Practice Address - Country:US
Practice Address - Phone:317-355-9320
Practice Address - Fax:317-355-9319
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002092A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000659644OtherANTHEM
IN200803950Medicaid
INP01456879OtherRR MEDICARE
INP01456879OtherRR MEDICARE
IN224290KMedicare PIN
IN234020BMedicare ID - Type Unspecified
INM400054855Medicare PIN
INQ63304Medicare UPIN
IN256630GMedicare PIN