Healthcare Provider Details

I. General information

NPI: 1598336364
Provider Name (Legal Business Name): JESSICA L. FORNASH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD
CINCINNATI OH
45209-1900
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-0833
  • Fax: 513-321-6063
Mailing address:
  • Phone: 513-351-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015831
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: