Provider Demographics
NPI:1699799494
Name:BARTELS, JANA (PA)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:BARTELS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:KEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 664056
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4056
Mailing Address - Country:US
Mailing Address - Phone:317-780-3333
Mailing Address - Fax:317-780-3345
Practice Address - Street 1:1001 HADLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1794
Practice Address - Country:US
Practice Address - Phone:317-831-9340
Practice Address - Fax:317-834-5768
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000800A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ48719Medicare UPIN
IN182470GMedicare PIN