Healthcare Provider Details

I. General information

NPI: 1902664485
Provider Name (Legal Business Name): JESSICA ELIZABETH NEWMAN APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ELIZABETH KOKER APRN-CNM

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 GLENN AVE
COLUMBUS OH
43212-2775
US

IV. Provider business mailing address

1508 GLENN AVE
COLUMBUS OH
43212-2775
US

V. Phone/Fax

Practice location:
  • Phone: 937-684-2789
  • Fax:
Mailing address:
  • Phone: 937-684-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-518435
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019644
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: