Healthcare Provider Details

I. General information

NPI: 1336065705
Provider Name (Legal Business Name): GAYLE JETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 RIVER RD
FAIRFIELD OH
45014-1606
US

IV. Provider business mailing address

352 LAURYN MEADOWS CT
FAIRFIELD OH
45014-2625
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-3021
  • Fax: 513-868-3624
Mailing address:
  • Phone: 513-868-3021
  • Fax: 513-868-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number335079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: