Provider Demographics
NPI:1144569203
Name:OSBURN, VERNON L (NP)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:OSBURN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:317-561-3177
Mailing Address - Fax:877-961-4275
Practice Address - Street 1:8101 PENDLETON PIKE STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4888
Practice Address - Country:US
Practice Address - Phone:317-561-3177
Practice Address - Fax:877-961-4275
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147623A163W00000X
IN71004358A363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201139210Medicaid
IN201139210Medicaid
IN264430069Medicare PIN