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MRS. ELLY JO FENNELL RN CNP NPI 1114245958


NPI Information

NPI: 1114245958
Provider Name: MRS. ELLY JO FENNELL, RN, CNP
Classification: Clinical Nurse Specialist - 364S00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
720 ESKENAZI AVE
INDIANAPOLIS, IN
ZIP 46202
Phone: (317) 880-7666
Get Directions

MRS. Elly Jo Fennell, RN, CNP is a clinical nurse specialist in Indianapolis, IN with 15 years of experience. The provider is a registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. MRS. Elly Jo Fennell, RN, CNP NPI is 1114245958. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

720 ESKENAZI AVE
INDIANAPOLIS, IN
ZIP 46202-187
Phone: (317) 880-7666

The NPI 1114245958 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)
  • Routine ekg using at least 12 leads including interpretation and report (HCPCS:93000)

The enumeration date for this NPI number is 5/4/2010 and was last updated on 11/18/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse Practitioner209.008173ILLINOISNo
2363LA2200XNurse PractitionerAdult Health209.008173ILLINOISNo
3363LA2200XNurse PractitionerAdult Health370911138ILLINOISNo
4364S00000XClinical Nurse Specialist71009460AINDIANAYes
5163W00000XRegistered Nurse041-280081ILLINOISNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1041-280081OTHERILLINOISRN LICENSE
2036102163MEDICAIDILLINOIS
3209.008173OTHERILLINOISCNP LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.