Healthcare Provider Details

I. General information

NPI: 1902721475
Provider Name (Legal Business Name): JAMIE LYNN SIMON RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 N COUNTY ROAD 25A
TROY OH
45373-1337
US

IV. Provider business mailing address

3130 N COUNTY ROAD 25A
TROY OH
45373-1337
US

V. Phone/Fax

Practice location:
  • Phone: 937-440-4000
  • Fax: 937-440-4373
Mailing address:
  • Phone: 937-440-4000
  • Fax: 937-440-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN.362767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: