MEDICARE: HEATHER GREENLEE PMHNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PMH02260060	IN

General Provider Information

NPI Number	:	1639027782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GREENLEE PMHNP-C

Provider Business Mailing Address
First Line	:	6447 S EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6447 S EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2118
Country	:	US
Telephone Number	:	317-781-0067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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