Healthcare Provider Details

I. General information

NPI: 1972450401
Provider Name (Legal Business Name): JUSTIN JARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 W LANE AVE
COLUMBUS OH
43210-1132
US

IV. Provider business mailing address

69 HARVEST LN
TIFFIN OH
44883-3346
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4041
  • Fax:
Mailing address:
  • Phone: 419-455-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042276
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.542342
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: