Healthcare Provider Details

I. General information

NPI: 1295074441
Provider Name (Legal Business Name): LYNN R FORD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 01/25/2022
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OLENTANGY RIVER RD STE A
COLUMBUS OH
43214-3437
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-583-5552
  • Fax: 614-583-5559
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number338309
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: