Healthcare Provider Details

I. General information

NPI: 1922688092
Provider Name (Legal Business Name): JESSICA LYNN OTIS DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 PAXTON AVE
CINCINNATI OH
45209-2399
US

IV. Provider business mailing address

338 MILTON ST APT 1
CINCINNATI OH
45202-0975
US

V. Phone/Fax

Practice location:
  • Phone: 513-376-9354
  • Fax:
Mailing address:
  • Phone: 513-497-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027834
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: