Healthcare Provider Details

I. General information

NPI: 1497422505
Provider Name (Legal Business Name): JEAN MCCULLOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 SUNBURY RD
COLUMBUS OH
43219-2612
US

IV. Provider business mailing address

979 SUNBURY RD
COLUMBUS OH
43219-2612
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-7485
  • Fax:
Mailing address:
  • Phone: 614-257-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.251777
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: