Provider Demographics
NPI:1982044764
Name:PADEN, JEREMY M (NP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:PADEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TECHNOLOGY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-8548
Mailing Address - Country:US
Mailing Address - Phone:812-941-4500
Mailing Address - Fax:
Practice Address - Street 1:4101 TECHNOLOGY AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8548
Practice Address - Country:US
Practice Address - Phone:812-941-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004480A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71004480AOtherPERSCRIPTIVE AUTHORITY
IN71004480BOtherCSR