Healthcare Provider Details

I. General information

NPI: 1922825439
Provider Name (Legal Business Name): JORDAN LEIGH RHYAN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9049 N SPRINGBORO PK
MIAMISBURG OH
45342
US

IV. Provider business mailing address

23 N MAIN ST PO BOX 18
NORTH HAMPTON OH
45349
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax:
Mailing address:
  • Phone: 937-684-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number414472
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: