Provider Demographics
NPI:1760825285
Name:JEANNE INGLES FAMILY PRACTICE
Entity Type:Organization
Organization Name:JEANNE INGLES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGLES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:740-446-7393
Mailing Address - Street 1:21 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1824
Mailing Address - Country:US
Mailing Address - Phone:740-446-7393
Mailing Address - Fax:740-446-7391
Practice Address - Street 1:21 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1824
Practice Address - Country:US
Practice Address - Phone:740-446-7393
Practice Address - Fax:740-446-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08936364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty