Healthcare Provider Details
I. General information
NPI: 1417397704
Provider Name (Legal Business Name): KORI NICOLE DEVOLL RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 07/01/2013
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1576
US
IV. Provider business mailing address
3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1576
US
V. Phone/Fax
- Phone: 614-754-5500
- Fax: 614-754-5501
- Phone: 614-754-5500
- Fax: 614-457-9519
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | COA.14852-NP |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 321399 |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: