Individual
JEREMY KEITH NIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2800 S STATE ROAD 135 STE 250, GREENWOOD, IN 46143-6223
(317) 300-1788
(317) 743-8103
Mailing address
111 NEW HAMPSHIRE AVE STE 2, PORTSMOUTH, NH 03801-2864
(330) 947-6021
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28198910A
IN
363L00000X
Nurse Practitioner
Primary
71005349A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530A
—
IN
Enumeration date
05/04/2007
Last updated
02/25/2026
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