Provider Demographics
NPI:1558646091
Name:ALLEN, JODI A (NP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:11161 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8564
Practice Address - Country:US
Practice Address - Phone:219-662-9424
Practice Address - Fax:219-662-7465
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003739A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000745867OtherANTHEM TRADITIONAL, BLUE ACCESS, PPO
IN201040780Medicaid
IN000000745867OtherANTHEM TRADITIONAL, BLUE ACCESS, PPO