Provider Demographics
NPI:1376070847
Name:NICKOLL, JANNA KASTING (FNP)
Entity Type:Individual
Prefix:MS
First Name:JANNA
Middle Name:KASTING
Last Name:NICKOLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JANNA
Other - Middle Name:LYNN
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:3015 10TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-7090
Practice Address - Country:US
Practice Address - Phone:812-372-8426
Practice Address - Fax:812-378-7777
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28135072A163WC0200X
IN71007158A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine