Provider Demographics
NPI:1104281344
Name:STYER, JENNIFER DAWN (FNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DAWN
Last Name:STYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:MASON (MARRIED); MCCASLIN (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:821 N STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1314
Mailing Address - Country:US
Mailing Address - Phone:317-560-4300
Mailing Address - Fax:317-530-9084
Practice Address - Street 1:821 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1314
Practice Address - Country:US
Practice Address - Phone:317-560-4300
Practice Address - Fax:317-530-9084
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006038A363LF0000X
IN28163132A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824798OtherRR PTAN
IN201345780Medicaid