Provider Demographics
NPI:1598250797
Name:BRISTOW, JAIME ALLISON (NP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ALLISON
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FLATBUSH AVE STE C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3706
Mailing Address - Country:US
Mailing Address - Phone:800-336-1100
Mailing Address - Fax:
Practice Address - Street 1:2620 KESSLER BOULEVARD EAST DR STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2889
Practice Address - Country:US
Practice Address - Phone:800-336-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28202301A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health