Provider Demographics
NPI:1043784200
Name:WELLER, JACQUELYN (NP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:WELLER
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 1:8038 N 600 W STE 100
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-8605
Mailing Address - Country:US
Mailing Address - Phone:317-932-3426
Mailing Address - Fax:855-631-0165
Practice Address - Street 1:8038 N 600 W STE 100
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-8605
Practice Address - Country:US
Practice Address - Phone:179-323-4263
Practice Address - Fax:855-563-1016
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008805A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily