Healthcare Provider Details

I. General information

NPI: 1760219737
Provider Name (Legal Business Name): JESSICA M PRIFOGLE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 LINCOLN AVE
EVANSVILLE IN
47715-7909
US

IV. Provider business mailing address

7666 PAMELA LN
NEWBURGH IN
47630-9554
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-3700
  • Fax:
Mailing address:
  • Phone: 812-202-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71016978A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4027665
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71016978A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: