Basic Information
| Provider Information | |||||||||
| NPI: | 1487659348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOVER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | F.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GLOVER | ||||||||
| OtherFirstName: | JEFFREY | ||||||||
| OtherMiddleName: | ALLEN | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | L.M.F.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985706 | ||||||||
| FaxNumber: | 7652984913 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652987500 | ||||||||
| FaxNumber: | 7652984913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 03/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39001330A | IN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 35000905A | IN | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 163W00000X | 28080875A | IN | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 71001412A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 35000905A | 01 | IN | LIC. MARR & FAM THERAPIST | OTHER | 39001330A | 01 | IN | LIC. MENTAL HTH COUNSELOR | OTHER | 71001412A | 01 | IN | INDIANA NURSE PRACTITIONE | OTHER | P01018464 | 01 | IN | RR MEDICARE | OTHER | 200503230 | 05 | IN | MEDICAID | 71001412D | 01 | IN | INDIANA CSR REGISTRATION | OTHER | MG0859934 | 01 | IN | DEA NUMBER | OTHER | 200400712-22 | 01 | IN | ANCC NAT. CERTIFICATION | OTHER | 28080875A | 01 | IN | INDIANA REGISTERED NURSE | OTHER |