Healthcare Provider Details

I. General information

NPI: 1982423091
Provider Name (Legal Business Name): CHEYENNE BAULT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3942 SNOWSHOE AVE
GROVE CITY OH
43123-1198
US

IV. Provider business mailing address

3942 SNOWSHOE AVE
GROVE CITY OH
43123-1198
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0042220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: