Healthcare Provider Details

I. General information

NPI: 1417726969
Provider Name (Legal Business Name): VERONICA YEBOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 E BROAD ST
COLUMBUS OH
43209-2055
US

IV. Provider business mailing address

PO BOX 248122
COLUMBUS OH
43224-8122
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-9101
  • Fax: 614-882-4664
Mailing address:
  • Phone:
  • Fax: 614-882-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0035552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: