Healthcare Provider Details

I. General information

NPI: 1225901176
Provider Name (Legal Business Name): JENNA MARIE LAUGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W JEFFERSON ST STE 101
FRANKLIN IN
46131-2731
US

IV. Provider business mailing address

PO BOX 800
FRANKLIN IN
46131-0800
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-6133
  • Fax: 317-736-6403
Mailing address:
  • Phone: 317-736-6133
  • Fax: 317-736-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005121A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: