Individual
JARED LORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7250 CLEARVISTA DR STE 355, INDIANAPOLIS, IN 46256-5609
(317) 621-5676
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28202720A
IN
363LF0000X
Family Nurse Practitioner
Primary
71007903A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30012615
—
IN
01
—
P02085768
MEDICARE RR
IN
Enumeration date
04/03/2018
Last updated
10/23/2018
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