Provider Demographics
NPI:1487659348
Name:GLOVER, JEFFREY ALLEN (FNP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:GLOVER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:ALLEN
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5706
Mailing Address - Fax:765-298-4913
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-7500
Practice Address - Fax:765-298-4913
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001330A101YM0800X
IN35000905A106H00000X
IN28080875A163W00000X
IN71001412A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35000905AOtherLIC. MARR & FAM THERAPIST
IN39001330AOtherLIC. MENTAL HTH COUNSELOR
IN71001412AOtherINDIANA NURSE PRACTITIONE
INP01018464OtherRR MEDICARE
IN200503230Medicaid
IN71001412DOtherINDIANA CSR REGISTRATION
IN200400712-22OtherANCC NAT. CERTIFICATION
IN28080875AOtherINDIANA REGISTERED NURSE
IN28080875AOtherINDIANA REGISTERED NURSE
INM400047949Medicare PIN
IN71001412DOtherINDIANA CSR REGISTRATION
IN35000905AOtherLIC. MARR & FAM THERAPIST
IN200400712-22OtherANCC NAT. CERTIFICATION