Provider Demographics
NPI:1750382446
Name:BARON, JEFFERY HOWARD (FNP)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:HOWARD
Last Name:BARON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3127
Mailing Address - Fax:
Practice Address - Street 1:386 SYMMES CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9402
Practice Address - Country:US
Practice Address - Phone:765-586-6600
Practice Address - Fax:765-547-6503
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000348A363LF0000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000296371OtherBC/BS #
IN200229820Medicaid
OH2293629Medicaid
OH2293629Medicaid
IN200856750Medicaid
IN200229820Medicaid
IN259370022Medicare PIN
IN200856750Medicaid