Provider Demographics
NPI:1174839260
Name:JOY, JEROME (RN)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:JOY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:215 S. PEARL ST.
Mailing Address - City:SPICELAND
Mailing Address - State:IN
Mailing Address - Zip Code:47385-0094
Mailing Address - Country:US
Mailing Address - Phone:765-987-8171
Mailing Address - Fax:
Practice Address - Street 1:6923 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2054
Practice Address - Country:US
Practice Address - Phone:765-987-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28159971A163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics