MRS. ELLY JO FENNELL (NPI# 1114245958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114245958 |
| Entity Type | Individual |
| Full Name | MRS. ELLY JO FENNELL |
| Other Name | ELLY J WEAR |
| Credential | RN, CNP |
| Practice Address |
3900 St Francis Way Ste 205 Lafayette IN 47905-4939 |
| Practice Telephone | 7654282500 |
| Practice Fax Number | 7654282505 |
| Mailing Telephone | 7654282500 |
| Mailing Fax Number | 7654282505 |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2020-08-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 041-280081 | IL | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | 209.008173 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
370911138 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
209.008173 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RN LICENSE | 041-280081 | 01 |
| IL | CNP LICENSE | 209.008173 | 01 |
| IL | 036102163 | 05 |
| Street Address |
3900 ST FRANCIS WAY STE 205 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905-4939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811987514 | George Kline Brodell | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2005-10-24 |
| 1245506401 | Elizabeth Marie Riddell | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2012-03-31 |
| 1174724371 | Ryan C Oeltgen | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2007-05-29 |
| 1245382852 | Fabian Jorge Arnaldo | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2007-01-17 |
| 1851353262 | Robert V Riddell | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2006-04-03 |
| 1841251592 | Jay D Schlaifer | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2006-03-31 |
| 1154397701 | Sam Hansen | Internal Medicine | 3900 St Francis Way Ste 205, Lafayette, IN 47905-4939 | 2006-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264594 | Neely Primary | Nurse Practitioner | 102 Independence Blvd, Lafayette, LA 70506-6085 | 2020-08-04 |
| 1215553359 | Sync Health LLC | Nurse Practitioner | 1300 Verot School Rd Ste D, Lafayette, LA 70508-5855 | 2020-06-24 |
| 1801422654 | Lindsay Spurgeon | Nurse Practitioner | 892 Belgian Ln, Lafayette, IN 47905-0794 | 2020-03-12 |
| 1033754692 | Harmony White | Nurse Practitioner | 1345 Unity Pl Ste 210, Lafayette, IN 47905-5762 | 2019-11-07 |
| 1962050591 | Stephanie Ching Wong | Nurse Practitioner | 1735 S Public Rd Ste 203, Lafayette, CO 80026-7093 | 2019-08-27 |
| 1407353543 | Dnprovider LLC | Nurse Practitioner | 312 Dunvegan Ct, Lafayette, LA 70503-6084 | 2018-04-06 |
| 1477065381 | Amber R Wattigny | Nurse Practitioner | 155 Hospital Dr Ste 100, Lafayette, LA 70503-2852 | 2017-11-01 |
| 1346765617 | Kristina Lynn Renfrow | Nurse Practitioner | 1345 Unity Pl Ste 310, Lafayette, IN 47905-5769 | 2017-08-08 |
| 1578086484 | Melissa Ann Donahue | Nurse Practitioner | 3900 St Francis Way Ste 220, Lafayette, IN 47905-4925 | 2017-07-23 |
| 1063944064 | Margaret Jordan Trawick | Nurse Practitioner | 110 Levison Way, Lafayette, LA 70508-7094 | 2017-03-29 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.