Individual
JENNIFER S. GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
14020 OLD STATE RD STE 400, EVANSVILLE, IN 47725-1121
(812) 428-2746
Mailing address
14020 OLD STATE RD STE C400, EVANSVILLE, IN 47725-0002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001650A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578786612
GROUP NPI
—
01
—
200859330Q
MEDICAID GROUP
IN
05
—
200961400
—
IN
Enumeration date
12/21/2006
Last updated
06/22/2022
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