JEFFERSON PEDIATRICS PC NPI 1134542855

NPI Information

  • NPI: 1134542855
  • Provider Name: JEFFERSON PEDIATRICS, PC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 01D0692716
  • Address: 3919 W JEFFERSON BLVD
    SUITE 1
    FORT WAYNE, IN
    ZIP 46804
  • Phone: (260) 436-7722

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NPI Details

JEFFERSON PEDIATRICS, PC is a family nurse practitioner in Fort Wayne, IN. JEFFERSON PEDIATRICS, PC NPI is 1134542855. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3919 W JEFFERSON BLVD
SUITE 1
FORT WAYNE, IN
ZIP 46804-811
Phone: (260) 436-7722

The provider's authorized official is Giridhar Veerula .
The authorized official title is Physician and has the following contact phone number (260) 436-7722.

The CLIA number assigned to this NPI record is 01D0692716 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/31/2014 and was last updated on 1/31/2014.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily71004759AINDIANAYes

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: 3/30/2025

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