Healthcare Provider Details

I. General information

NPI: 1962040394
Provider Name (Legal Business Name): JESSICA DAYTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6413 THORNBERRY CT
MASON OH
45040-7821
US

IV. Provider business mailing address

6413 THORNBERRY CT
MASON OH
45040-7821
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-0787
  • Fax: 513-770-0144
Mailing address:
  • Phone: 513-770-0787
  • Fax: 513-770-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number374079
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016094
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025762
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: