Healthcare Provider Details

I. General information

NPI: 1669369815
Provider Name (Legal Business Name): BENETTA NYENPAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 HILL RD N STE A
PICKERINGTON OH
43147-9201
US

IV. Provider business mailing address

670 HILL RD N STE A
PICKERINGTON OH
43147-9201
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-4343
  • Fax:
Mailing address:
  • Phone: 614-882-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberAPRNCNP0039507
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRNCNP0039507
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRNCNP0039507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: