Individual provider Active NPI

Jennifer Sue Wood, APRN PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lafayette, IN
National Provider Identifier
1255039244
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71013820A Issued in IN
Practice address
100 Executive Dr
Lafayette, IN 47905-4884
Phone
(765) 537-3880
Fax
(765) 548-4332
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71013820A IN Primary

Addresses

Primary practice location

100 Executive Dr
Lafayette, IN 47905-4884

Mailing address

7611 S 350 E
Lafayette, IN 47909-8112
Phone (765) 537-3880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231005001397 IN Practitioner - Nurse Practitioner 4082069455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

100 Executive Dr D
Woodhaven Behavioral LLC
Lafayette, IN 47905-4863
Phone (765) 586-4764

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71013820AINMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mending Minds, LLC CurrentSince Aug 25, 2023 Accepting new patients
Jennswood Enterprise LLC Psychiatric/Mental Health CurrentSince Jun 10, 2024 Accepting new patients
Family Psychiatric Center LLC Psychiatric/Mental Health CurrentSince Aug 25, 2023 Accepting new patients

Locations

1311 W 96th St
Ste 110
Indianapolis, IN 46260
Phone (317) 296-7707

702 W Alto Rd
Kokomo, IN 46902
Phone (765) 453-7422

100 Executive Dr
Ste D
Lafayette, IN 47905
Phone (765) 491-3100

3601 Sagamore Pkwy N
Ste G
Lafayette, IN 47904
Phone (765) 232-3503

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24167/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1255039244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 S 350 E",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479098112",
            "telephone_number": "765-537-3880",
            "fax_number": "765-548-4332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXECUTIVE DR",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479054884",
            "telephone_number": "765-537-3880",
            "fax_number": "765-548-4332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "credential": "APRN PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71013820A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.