Provider Demographics
NPI:1164144150
Name:JL CHENOWITH
Entity Type:Organization
Organization Name:JL CHENOWITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENOWITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:317-268-6555
Mailing Address - Street 1:4265 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9174
Mailing Address - Country:US
Mailing Address - Phone:317-268-6555
Mailing Address - Fax:
Practice Address - Street 1:4265 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9174
Practice Address - Country:US
Practice Address - Phone:317-268-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty