Provider Demographics
NPI:1184115677
Name:FIDLER, JESSICA A (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:FIDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 INDIANAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2408
Mailing Address - Country:US
Mailing Address - Phone:765-653-8453
Mailing Address - Fax:765-653-8493
Practice Address - Street 1:1145 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2408
Practice Address - Country:US
Practice Address - Phone:765-653-8453
Practice Address - Fax:657-653-8493
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
IN02006310A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program