Provider Demographics
NPI:1851284467
Name:VAN HOORDE, JESSICA RAE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:VAN HOORDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1906
Mailing Address - Country:US
Mailing Address - Phone:812-272-9287
Mailing Address - Fax:
Practice Address - Street 1:820 N SAMUEL MOORE PKWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1467
Practice Address - Country:US
Practice Address - Phone:317-483-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF05250778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty