Provider Demographics
NPI:1346834652
Name:BURNELL, JESSICA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BURNELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 MASTEN RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46121-9204
Mailing Address - Country:US
Mailing Address - Phone:317-728-6469
Mailing Address - Fax:
Practice Address - Street 1:3600 N PROW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1616
Practice Address - Country:US
Practice Address - Phone:812-331-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28227809A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health