Healthcare Provider Details

I. General information

NPI: 1710536818
Provider Name (Legal Business Name): JOSHUA J USSERMAN APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 US HIGHWAY 68 S
WEST LIBERTY OH
43357-9525
US

IV. Provider business mailing address

212 E COLUMBUS AVE STE 1
BELLEFONTAINE OH
43311-2033
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-1411
  • Fax:
Mailing address:
  • Phone: 937-599-1411
  • Fax: 937-599-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.025594
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025594
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: