Healthcare Provider Details

I. General information

NPI: 1285200998
Provider Name (Legal Business Name): JESSICA LYTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 COSHOCTON AVE STE I
MOUNT VERNON OH
43050-1900
US

IV. Provider business mailing address

406 LAKE ST
LANCASTER OH
43130-2659
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-2639
Mailing address:
  • Phone: 614-674-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: