Healthcare Provider Details

I. General information

NPI: 1316491673
Provider Name (Legal Business Name): DAVID PETER GLENN PMHNP-BC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 111
COLUMBUS OH
43214
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 111
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-427-3205
  • Fax: 727-677-0064
Mailing address:
  • Phone: 614-427-3205
  • Fax: 727-677-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029457
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.401849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: