Active NPI
Jill Van Tholen
- Nurse Practitioner
- Saint John, IN
National Provider Identifier
1477955201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71005137A
- Practice address
- 9495 Keilman St Ste 6
Saint John, IN 46373-9295 - Phone
- (219) 440-1232
- Fax
- (219) 285-5687
- NPI assigned
- Sep 24, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71005137A | IN | Primary |
Addresses
Primary practice location
9495 Keilman St Ste 6
Saint John, IN 46373-9295
Mailing address
9495 Keilman St Ste 6
Saint John, IN 46373-9295
Phone (219) 440-1232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2026 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71005137A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742342400000",
"number": "1477955201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9495 KEILMAN ST STE 6",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463739295",
"telephone_number": "219-440-1232",
"fax_number": "219-285-5687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9495 KEILMAN ST STE 6",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463739295",
"telephone_number": "219-440-1232",
"fax_number": "219-285-5687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN THOLEN",
"first_name": "JILL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-24",
"last_updated": "2025-03-19",
"certification_date": "2025-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71005137A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint John, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.