Healthcare Provider Details

I. General information

NPI: 1225557168
Provider Name (Legal Business Name): JUSTINA BREIGHANN WELLMAN AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COUNTY LINE RD STE 101
GREENWOOD IN
46143-1070
US

IV. Provider business mailing address

701 E COUNTY LINE RD STE 101
GREENWOOD IN
46143-1070
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-2860
  • Fax: 317-885-2869
Mailing address:
  • Phone: 317-885-2860
  • Fax: 317-885-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71007552A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71007552A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71007552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: