Provider Demographics
NPI:1881972784
Name:TAULMAN-YOUNG, JESSICA RUTH (DPM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:TAULMAN-YOUNG
Suffix:
Gender:F
Credentials:DPM
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 330
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-0330
Mailing Address - Country:US
Mailing Address - Phone:317-863-2556
Mailing Address - Fax:317-203-0420
Practice Address - Street 1:6021 W 71ST ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1705
Practice Address - Country:US
Practice Address - Phone:317-920-3240
Practice Address - Fax:317-920-3243
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001159A213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12568529OtherCAQH
IN223300001OtherMEDICARE PTAN
IN201103700Medicaid
IN000000838854OtherANTHEM
IN12568529OtherCAQH