Healthcare Provider Details

I. General information

NPI: 1417871765
Provider Name (Legal Business Name): FATOUMATA BINTA BAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5593 JENNYBROOK LN
HILLIARD OH
43026-8138
US

IV. Provider business mailing address

5593 JENNYBROOK LN
HILLIARD OH
43026-8138
US

V. Phone/Fax

Practice location:
  • Phone: 614-589-7745
  • Fax:
Mailing address:
  • Phone: 614-589-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0042913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: