Provider Demographics
NPI:1598354847
Name:HIPPENMEYER, JILL (FNP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HIPPENMEYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:1155 W JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2731
Practice Address - Country:US
Practice Address - Phone:317-736-6133
Practice Address - Fax:317-736-6403
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF01210458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300048418Medicaid