Provider Demographics
NPI:1467822049
Name:VANIGLIA, JESSICA R (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:VANIGLIA
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:KIRST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:11595 N MERIDIAN ST STE 375
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3950
Mailing Address - Country:US
Mailing Address - Phone:317-575-7304
Mailing Address - Fax:317-575-7333
Practice Address - Street 1:6903 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1618
Practice Address - Country:US
Practice Address - Phone:859-282-6700
Practice Address - Fax:859-282-6760
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1103945363L00000X
KY3009797367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ00076709OtherRR MEDICARE
KY7100407100Medicaid
OH0156451Medicaid
OH0156451Medicaid