Provider Demographics
NPI:1255039244
Name:WOOD, JENNIFER SUE (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:WOOD
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 S 350 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8112
Mailing Address - Country:US
Mailing Address - Phone:765-537-3880
Mailing Address - Fax:765-548-4332
Practice Address - Street 1:100 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4884
Practice Address - Country:US
Practice Address - Phone:765-537-3880
Practice Address - Fax:765-548-4332
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013820A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health