Healthcare Provider Details

I. General information

NPI: 1326218959
Provider Name (Legal Business Name): GREGORY JAMES GAST ACNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREGORY JAMES GAST NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10706 E US HIGHWAY 36
AVON IN
46123-7982
US

IV. Provider business mailing address

10706 E US HIGHWAY 36
AVON IN
46123-7982
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-3600
  • Fax: 317-271-3604
Mailing address:
  • Phone: 317-271-3600
  • Fax: 317-271-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70000205A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number70000205A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number70000205 B- CSR
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: