Provider Demographics
NPI:1013384361
Name:DUERKSEN, JESSICA TENNILLE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TENNILLE
Last Name:DUERKSEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1146
Mailing Address - Country:US
Mailing Address - Phone:317-291-7422
Mailing Address - Fax:
Practice Address - Street 1:3400 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1146
Practice Address - Country:US
Practice Address - Phone:317-291-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005672A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics