Healthcare Provider Details

I. General information

NPI: 1053644831
Provider Name (Legal Business Name): SHERI PATRICE COLVIN-JACKSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 READING RD STE B
CINCINNATI OH
45237-3203
US

IV. Provider business mailing address

7601 READING RD STE B
CINCINNATI OH
45237-3203
US

V. Phone/Fax

Practice location:
  • Phone: 513-653-0281
  • Fax: 513-653-0098
Mailing address:
  • Phone: 513-653-0281
  • Fax: 513-653-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAPRN.CNP.0034201
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0034201
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number287003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: