Healthcare Provider Details

I. General information

NPI: 1063082782
Provider Name (Legal Business Name): JENNIFER LEE HERRICK APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-3427
US

IV. Provider business mailing address

444 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-3427
US

V. Phone/Fax

Practice location:
  • Phone: 614-938-0167
  • Fax: 614-938-0170
Mailing address:
  • Phone: 614-938-0167
  • Fax: 614-938-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: