Addiction Wellness Center In LLC
Physician Assistant in Jeffersonville, IN. Organization (NPI-2).
NPI number1740197136
StatusActive
Last updated in NPPESAug 24, 2026
Details
- NPI
- 1740197136
- Entity type
- Organization (NPI-2)
- Legal business name
- Addiction Wellness Center In LLC
- Organization subpart
- Yes
- Enumeration date
- Aug 24, 2026
- Certification date
- Aug 24, 2026
- Last updated
- Aug 24, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
202 E Maple StJeffersonville, IN 47130-3420
Phone 812-850-0619 · Fax 317-458-1794
Mailing address
1100 Business Pkwy S Ste 1Westminster, MD 21157-3048
Phone 812-850-0619 · Fax 317-458-1794
Authorized official
Jessie Costley
Credentialing Manager
4434523149
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