=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609178755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACLYN A LANHAM NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2010
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 S 3RD ST STE 210
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-902-9298
-----------------------------------------------------
Fax | 330-305-2878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 S 3RD ST STE 210
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-902-9298
-----------------------------------------------------
Fax | 330-305-2878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11881NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | CNP.11881
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.11881
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------