Healthcare Provider Details

I. General information

NPI: 1922824861
Provider Name (Legal Business Name): COMFORT OKINE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 FOLSOM DR
GROVEPORT OH
43125-9149
US

IV. Provider business mailing address

5295 FOLSOM DR
GROVEPORT OH
43125-9149
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-4898
  • Fax:
Mailing address:
  • Phone: 614-615-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-CNP.0037809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: