Healthcare Provider Details

I. General information

NPI: 1467844886
Provider Name (Legal Business Name): KRYSTAL LEIGH JALOVEC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL LEIGH HOLTCAMP PA-C

II. Dates (important events)

Enumeration Date: 02/22/2015
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CRESCENT PL
GAHANNA OH
43230-3086
US

IV. Provider business mailing address

340 POLARIS PKWY
WESTERVILLE OH
43082-7971
US

V. Phone/Fax

Practice location:
  • Phone: 614-545-7900
  • Fax: 614-545-7901
Mailing address:
  • Phone: 614-545-7900
  • Fax: 614-545-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004315RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: