Healthcare Provider Details

I. General information

NPI: 1194300616
Provider Name (Legal Business Name): JESSICA PAIGE PEPPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-3427
US

IV. Provider business mailing address

5817 BLENDON PLACE DR
COLUMBUS OH
43230-9823
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2000
  • Fax:
Mailing address:
  • Phone: 330-933-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.472525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: