Healthcare Provider Details

I. General information

NPI: 1376814996
Provider Name (Legal Business Name): PATRICE ELLEN RANCOUR MS, RN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 KENNY RD
COLUMBUS OH
43221-3555
US

IV. Provider business mailing address

2000 KENNY RD
COLUMBUS OH
43221-3555
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-7777
  • Fax: 614-293-9776
Mailing address:
  • Phone: 614-293-7777
  • Fax: 614-293-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCOA01381 NS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN-125605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: