Provider Demographics
NPI:1326218959
Name:GAST, GREGORY JAMES (ACNS-BC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:GAST
Suffix:
Gender:M
Credentials:ACNS-BC
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:JAMES
Other - Last Name:GAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:10706 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7982
Mailing Address - Country:US
Mailing Address - Phone:317-271-3600
Mailing Address - Fax:317-271-3604
Practice Address - Street 1:10706 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7982
Practice Address - Country:US
Practice Address - Phone:317-271-3600
Practice Address - Fax:317-271-3604
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000205A363L00000X, 364SA2200X
IN70000205 B- CSR364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN# 8516128094OtherCERTIFIED MEDICAL EXAMINER FOR THE FMCSA
IN70000205AOtherADVANCED PRACTICE LICENSURE
INLPI # 201262530Medicaid
IN11832397OtherCAQH #
IN28132624AOtherREGISTERED NURSE LICENSURE
IN11832397OtherCAQH
IN70000205BOtherCONTROLLED SUBSTANCE REGISTRATION
IN1326218959OtherNATIONAL PROVIDER INFORMATION
IN2006010571OtherAMERICAN NURSES CREDENTIALING CENTER
IN2006010571OtherAMERICAN NURSES CREDENTIALING CENTER
IN11832397OtherCAQH