NPI 1740197136 · live from the CMS NPI Registry
Addiction Wellness Center In LLC
Physician Assistant in Jeffersonville, IN. National Provider Identifier 1740197136, active.
NPI record
| NPI | 1740197136 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 202 E Maple St, Jeffersonville, IN 47130 |
| Practice phone | 812-850-0619 |
| Mailing address | 1100 Business Pkwy S Ste 1, Westminster, MD 21157 |
| Enumerated | August 24, 2026 |
| Last updated | August 24, 2026 |
| Authorized official | Jessie Costley, Credentialing Manager |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | — |
| Nurse Practitioner | 363L00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.