Healthcare Provider Details

I. General information

NPI: 1427507995
Provider Name (Legal Business Name): JENNIFER ROBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S JEFFERSON AVE STE 500
PLAIN CITY OH
43064-4137
US

IV. Provider business mailing address

480 S JEFFERSON AVE STE 500
PLAIN CITY OH
43064-4137
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-3434
  • Fax:
Mailing address:
  • Phone: 614-873-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.375214
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFAMILY NP - 363LF000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: