Provider Demographics
NPI:1346209392
Name:CODDINGTON, JENNIFER ANN (DNP, MSN, RN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:CODDINGTON
Suffix:
Gender:F
Credentials:DNP, MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N UNIVERSITY ST
Mailing Address - Street 2:JOHNSON HALL RM B-5
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2069
Mailing Address - Country:US
Mailing Address - Phone:765-494-6341
Mailing Address - Fax:765-496-1022
Practice Address - Street 1:502 N UNIVERSITY ST
Practice Address - Street 2:JOHNSON HALL RM B-5
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2069
Practice Address - Country:US
Practice Address - Phone:765-494-6341
Practice Address - Fax:765-496-1022
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000722A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200299820Medicaid
IN9397700OtherPHCS PID NUMBER
IN000000351155OtherANTHEM PROVIDER NUMBER
IN815460YYYMedicare PIN
IN000000351155OtherANTHEM PROVIDER NUMBER
INP89009Medicare UPIN
INP00027750Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
IN200299820Medicaid
IN815500A7Medicare PIN