Provider Demographics
NPI:1154476976
Name:HENDRICKS, JOHN EVERETT JR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EVERETT
Last Name:HENDRICKS
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:5411 W 78TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4150
Mailing Address - Country:US
Mailing Address - Phone:317-876-6928
Mailing Address - Fax:317-876-6931
Practice Address - Street 1:5411 W 78TH ST
Practice Address - Street 2:JOHNS HOPKINS UNIVERSITY/PEPSICO HEALTH & WELLNESS CTR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4150
Practice Address - Country:US
Practice Address - Phone:317-876-6928
Practice Address - Fax:317-876-6931
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10001247A/B363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant