Healthcare Provider Details

I. General information

NPI: 1487659348
Provider Name (Legal Business Name): JEFFREY ALLEN GLOVER F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY ALLEN GLOVER L.M.F.T.

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MEDICAL ARTS BLVD SUITE 100
ANDERSON IN
46011-3458
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-7500
  • Fax: 765-298-4913
Mailing address:
  • Phone: 765-298-5706
  • Fax: 765-298-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71001412A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001330A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000905A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28080875A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: