Healthcare Provider Details

I. General information

NPI: 1124198825
Provider Name (Legal Business Name): JEANNE ANNE CLEMENT EDD APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD BLDG C128 CENTRAL OHIO BEHAVIORAL MEDICINE INC
COLUMBUS OH
43220-2553
US

IV. Provider business mailing address

1180 WORTHINGTON HGTS BLVD
COLUMBUS OH
43235
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-8300
  • Fax: 614-538-1656
Mailing address:
  • Phone: 614-888-7659
  • Fax: 614-292-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 0762881
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberNS 02778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: