Provider Demographics
NPI:1225571219
Name:HELMS, JACKIE MARIE (NP)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:HELMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:EL-DARAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5177 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-838-6717
Practice Address - Fax:765-838-4334
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015153363LF0000X
IN71015684A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1104578847OtherANTHEM PTAN
IN300097528Medicaid