Provider Demographics
NPI:1285718973
Name:MOHLER, JAYNE (NP)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:MOHLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W SYCAMORE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4183
Mailing Address - Country:US
Mailing Address - Phone:765-452-6011
Mailing Address - Fax:
Practice Address - Street 1:1907 W SYCAMORE ST STE 250
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4183
Practice Address - Country:US
Practice Address - Phone:765-452-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500013124Medicare PIN
IN151560K7Medicare PIN
INS61079Medicare UPIN
IN151990MMedicare PIN