Healthcare Provider Details

I. General information

NPI: 1356278436
Provider Name (Legal Business Name): JESSICA CARPENTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 JENNYANN WAY
CANAL WINCHESTER OH
43110-8636
US

IV. Provider business mailing address

6760 JENNYANN WAY
CANAL WINCHESTER OH
43110-8636
US

V. Phone/Fax

Practice location:
  • Phone: 740-507-8425
  • Fax:
Mailing address:
  • Phone: 740-507-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: