Healthcare Provider Details

I. General information

NPI: 1801770938
Provider Name (Legal Business Name): JAYLEEL FRAZIER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4094 CHARTER OAK WAY
COLUMBUS OH
43219-6090
US

IV. Provider business mailing address

4094 CHARTER OAK WAY
COLUMBUS OH
43219-6090
US

V. Phone/Fax

Practice location:
  • Phone: 614-603-1843
  • Fax:
Mailing address:
  • Phone: 614-603-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number542627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: