Provider Demographics
NPI:1316599954
Name:KANE, JESSICA (NP-F)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:NP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:900 I ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5533
Practice Address - Country:US
Practice Address - Phone:219-324-1700
Practice Address - Fax:219-324-1602
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF07190808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300032399Medicaid
IN300032399Medicaid