Provider Demographics
NPI:1467930396
Name:FELTNER, ARIEL ANN (FNP)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:ANN
Last Name:FELTNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:ANN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-5212
Mailing Address - Fax:812-847-6166
Practice Address - Street 1:55 N JUDGE ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1231
Practice Address - Country:US
Practice Address - Phone:812-847-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28225321A163W00000X
IN71008379A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300019083Medicaid