Individual
MRS. JERELYN J. GUMERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3834 S EMERSON AVE, BUILDING C, SUITE 100, INDIANAPOLIS, IN 46203
(317) 782-1577
(317) 780-5539
Mailing address
PO BOX 3299, CARSON CITY, NV 89702-3299
(775) 222-0044
(888) 700-0187
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
71000562A
IN
2084P0805X
Geriatric Psychiatry Physician
71000562A
IN
363LF0000X
Family Nurse Practitioner
Primary
71000562A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200215810
—
IN
01
—
P01424889
MEDICARE RAILROAD PIN
IN
Enumeration date
02/12/2006
Last updated
08/02/2018
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