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General NPI Number Information
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NPI Number | 1780896431
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Entity Type | Individual
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Provider Name | JEREMY KEITH NIVENS NP
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1100 SOUTHFIELD DR STE 1240
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City | PLAINFIELD
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State | IN
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Zip | 46168-4499
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Country | US
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Telephone | 317-838-9911
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Fax | 317-837-6080
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Provider Business Mailing Address
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Address Line | 111 NEW HAMPSHIRE AVE STE 2
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City | PORTSMOUTH
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State | NH
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Zip | 03801-2864
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Country | US
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Telephone | 330-947-6021
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28198910A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71005349A
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License Number State | IN
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