Healthcare Provider Details

I. General information

NPI: 1871413559
Provider Name (Legal Business Name): JODY ELAINE LANFORD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 GEORGETOWN RD
INDIANAPOLIS IN
46254-3781
US

IV. Provider business mailing address

7547 INNISMORE DR
BROWNSBURG IN
46112-5607
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-5404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71018494A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28172160A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: