Provider Demographics
NPI:1427118421
Name:KRATOCHVIL, JANE A (FNP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:A
Last Name:KRATOCHVIL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1775
Mailing Address - Country:US
Mailing Address - Phone:812-426-6152
Mailing Address - Fax:812-426-6160
Practice Address - Street 1:265 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1775
Practice Address - Country:US
Practice Address - Phone:812-426-6152
Practice Address - Fax:812-426-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001390A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423410AMedicaid
IN71001390AOtherLICENSE NUMBER
IN71001390AOtherLICENSE NUMBER
IN200423410AMedicaid
INMK0888884OtherDEA NUMBER