Healthcare Provider Details

I. General information

NPI: 1285196428
Provider Name (Legal Business Name): RAE LYNN EYRE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 DENNISON AVE
COLUMBUS OH
43201-3201
US

IV. Provider business mailing address

89 E 200 S UNIT 2508
SALT LAKE CITY UT
84111-2358
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-4455
  • Fax:
Mailing address:
  • Phone: 614-288-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024447
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: