Provider Demographics
NPI:1124262357
Name:CLEVENGER, JESSICA ASHLI (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLI
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 W 11TH ST
Mailing Address - Street 2:ROOM 4070
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4108
Mailing Address - Country:US
Mailing Address - Phone:317-491-6350
Mailing Address - Fax:317-491-6411
Practice Address - Street 1:350 W 11TH ST
Practice Address - Street 2:ROOM 4070
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4108
Practice Address - Country:US
Practice Address - Phone:317-491-6350
Practice Address - Fax:317-491-6411
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2015-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY48403207ZP0102X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology