Provider Demographics
NPI:1659345239
Name:RADICE, JENNIFER RACHELLE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHELLE
Last Name:RADICE
Suffix:
Gender:
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0007
Mailing Address - Country:US
Mailing Address - Phone:812-738-3086
Mailing Address - Fax:
Practice Address - Street 1:1263 HOSPITAL DR NW STE 280
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2174
Practice Address - Country:US
Practice Address - Phone:812-738-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260019363L00000X
IN71001559A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400050240Medicare UPIN
KYK006540Medicare UPIN