Healthcare Provider Details

I. General information

NPI: 1710382775
Provider Name (Legal Business Name): JAIME LYNN HEISTERKAMP NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2014
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 ALL SEASONS DR STE 160
HILLIARD OH
43026-1962
US

IV. Provider business mailing address

5400 FRANTZ RD STE 250
DUBLIN OH
43016-6102
US

V. Phone/Fax

Practice location:
  • Phone: 614-541-2676
  • Fax:
Mailing address:
  • Phone: 614-533-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.16605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: