Provider Demographics
NPI:1053341198
Name:SEACAT, JACQUELINE L (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:SEACAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46061-0869
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:865 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8901
Practice Address - Country:US
Practice Address - Phone:317-776-3854
Practice Address - Fax:317-776-3854
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001245A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000393337OtherANTHEM PROVIDER NUMBER
IN200832720Medicaid
ININ1663061Medicare PIN
INP42850Medicare UPIN
IN200832720Medicaid
IN177280059Medicare PIN
INP00366736Medicare PIN