Healthcare Provider Details

I. General information

NPI: 1265008973
Provider Name (Legal Business Name): JACQUELINE CHRISTINE JEPSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 UNIVERSITY BLVD
DUBLIN OH
43016-3508
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-4614
  • Fax: 614-685-5025
Mailing address:
  • Phone: 614-685-4614
  • Fax: 614-685-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.151160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: