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General NPI Number Information
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NPI Number | 1679148472
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Entity Type | Individual
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Provider Name | JENNIFER LEA GREGORY MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 675 JUSTICE WAY ROOM C0049
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City | INDIANAPOLIS
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State | IN
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Zip | 46203
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Country | US
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Telephone | 877-465-6650
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Fax | 804-294-2775
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Provider Business Mailing Address
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Address Line | 898 E MAIN ST
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City | GREENWOOD
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State | IN
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Zip | 46143-1407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71011226A
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License Number State | IN
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