Healthcare Provider Details

I. General information

NPI: 1285208595
Provider Name (Legal Business Name): JOHN DAY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 TAYLOR RD
COLUMBUS OH
43230-3766
US

IV. Provider business mailing address

628 OAK GALE LN
COLUMBUS OH
43228-2719
US

V. Phone/Fax

Practice location:
  • Phone: 512-773-7565
  • Fax:
Mailing address:
  • Phone: 512-773-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027661
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027661
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.458990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: