Jacob Gregory Huseman

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71009696A Issued in IN

Practice address

4321 Fir St
East Chicago, IN 46312-3049

Phone

(219) 703-1764

NPI assigned

Oct 21, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1699318899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 FIR ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123049",
            "telephone_number": "219-331-9169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 FIR ST",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463123049",
            "telephone_number": "219-703-1764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4320 Fir St",
            "address_2": "Ste 216",
            "address_purpose": "LOCATION",
            "city": "East Chicago",
            "state": "IN",
            "postal_code": "463123076",
            "country_code": "US",
            "telephone_number": "219-392-7025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUSEMAN",
        "first_name": "JACOB",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-21",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71009696A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in East Chicago, IN
• Providers in East Chicago, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.