Healthcare Provider Details

I. General information

NPI: 1184300626
Provider Name (Legal Business Name): JELEA MARIE SMITH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-9994
  • Fax: 614-685-9993
Mailing address:
  • Phone: 614-685-9994
  • Fax: 614-685-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033987
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: