Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 7003994A | IN |
NPI | 1033473012 |
---|---|
Provider Name | Jessica Ann Hart |
First Address | Indianapolis, IN 46260-2036 |
Second Address | Indianapolis, IN 46260-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 25/06/2012 |