Healthcare Provider Details

I. General information

NPI: 1134495237
Provider Name (Legal Business Name): JESSICA MARIE BOCKENSTEDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GRANT AVE
COLUMBUS OH
43215-4701
US

IV. Provider business mailing address

285 E STATE ST STE 520
COLUMBUS OH
43215-4359
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9000
  • Fax:
Mailing address:
  • Phone: 614-566-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35123003
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-123003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: