Healthcare Provider Details

I. General information

NPI: 1487342325
Provider Name (Legal Business Name): JENNIFER ROTH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 FORRER BLVD STE 250
KETTERING OH
45420-3640
US

IV. Provider business mailing address

1050 FORRER BLVD STE 250
KETTERING OH
45420-3640
US

V. Phone/Fax

Practice location:
  • Phone: 800-986-4801
  • Fax: 937-684-9990
Mailing address:
  • Phone: 800-986-4801
  • Fax: 937-684-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033651
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: