Healthcare Provider Details

I. General information

NPI: 1124964192
Provider Name (Legal Business Name): MS. JAMEKA J PENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E 29TH ST
INDIANAPOLIS IN
46205-4160
US

IV. Provider business mailing address

2434 W 67TH ST
INDIANAPOLIS IN
46268-2722
US

V. Phone/Fax

Practice location:
  • Phone: 317-292-5123
  • Fax:
Mailing address:
  • Phone: 317-496-5094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: