Healthcare Provider Details

I. General information

NPI: 1265378392
Provider Name (Legal Business Name): JESSICA RENEE SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 BACH LN
FAIRFIELD OH
45014-1900
US

IV. Provider business mailing address

401 CLARA DR
TRENTON OH
45067-1109
US

V. Phone/Fax

Practice location:
  • Phone: 513-829-6300
  • Fax:
Mailing address:
  • Phone: 513-594-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number338280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: