MEDICARE: JENNIFFER LEE PRICE NP

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	363LG0600X	Gerontology Nurse Practitioner	025845	OH
2	363LG0600X	Gerontology Nurse Practitioner	4053258	KY
3	363LG0600X	Gerontology Nurse Practitioner	71008392A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4053258	OTHER	KY	KENTUCKY STATE LICENSE
2	71008392A	OTHER	IN	INDIANA STATE LICENSE
3	025845	OTHER	OH	OHIO STATE LICENSE

General Provider Information

NPI Number	:	1881160885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFFER LEE PRICE NP

Provider Business Mailing Address
First Line	:	3512 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4631
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:	260-483-9196

Provider Business Practice Location Address
First Line	:	3512 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4631
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:	260-483-9196

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	05/15/2026

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