Healthcare Provider Details

I. General information

NPI: 1255506077
Provider Name (Legal Business Name): JODI MARIE BEACHY NURSE PRACTITIONER N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD
COLUMBUS OH
43228
US

IV. Provider business mailing address

700 CHILDRENS DRIVE
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-1075
  • Fax: 614-544-1718
Mailing address:
  • Phone: 614-722-6510
  • Fax: 614-722-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOARX00243
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNCCBEA104277541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: