Provider Demographics
NPI:1881144715
Name:AMBLER, JESSAMYN R (NP)
Entity type:Individual
Prefix:
First Name:JESSAMYN
Middle Name:R
Last Name:AMBLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSAMYN
Other - Middle Name:R
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:SUITE 0860
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-8620
Practice Address - Fax:317-944-8080
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006594A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN063220021OtherMEDICARE
IN201398460Medicaid