Healthcare Provider Details

I. General information

NPI: 1528934171
Provider Name (Legal Business Name): JAMERAH D COSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4272 LIGHTHOUSE LN
WEST CHESTER OH
45069-9631
US

IV. Provider business mailing address

4272 LIGHTHOUSE LN
WEST CHESTER OH
45069-9631
US

V. Phone/Fax

Practice location:
  • Phone: 513-328-3886
  • Fax:
Mailing address:
  • Phone: 513-328-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number519586
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number519586
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number519586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: