Healthcare Provider Details

I. General information

NPI: 1134041973
Provider Name (Legal Business Name): JAMA AGRESTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9443 E 38TH ST
INDIANAPOLIS IN
46235-2132
US

IV. Provider business mailing address

443 TRACEWOOD BND
GREENFIELD IN
46140-7094
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-2100
  • Fax:
Mailing address:
  • Phone: 317-880-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28216340A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: