Provider Demographics
NPI:1629521976
Name:BLEEKE, JADYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JADYN
Middle Name:
Last Name:BLEEKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JADYN
Other - Middle Name:
Other - Last Name:YARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-806-8260
Mailing Address - Fax:317-806-8296
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-806-8260
Practice Address - Fax:317-806-8296
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002082A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant