Healthcare Provider Details

I. General information

NPI: 1821819160
Provider Name (Legal Business Name): IVY NYARKO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5888 CLEVELAND AVE
COLUMBUS OH
43231-2860
US

IV. Provider business mailing address

5888 CLEVELAND AVE
COLUMBUS OH
43231-2860
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-4343
  • Fax:
Mailing address:
  • Phone: 614-882-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN433299
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0036558
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: