Provider Demographics
NPI:1053345462
Name:RONEY, JENNIFER D (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:RONEY
Suffix:
Gender:F
Credentials:MD
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 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E STATE ROAD 62 STE 2F
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0856
Practice Address - Fax:812-801-0771
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200298420Medicaid
KY2448323000OtherPASSPORT ADVANTAGE
IN000000365691OtherANTHEM BCBS
7186649OtherAETNA
IN059906OtherSIHO
KY50007150OtherPASSPORT KY MEDICAID
KY64107253Medicaid
KY64107253Medicaid
KY50007150OtherPASSPORT KY MEDICAID
IN000000365691OtherANTHEM BCBS
IN412840UUMedicare PIN