MEDICARE: AMANDA C JETT CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APRN.CNP.022871	OH
2	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.022871	OH
3	208000000X	Pediatrics Physician	APRN.CNP.022871	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225522634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA C JETT CPNP-PC

Provider Business Mailing Address
First Line	:	575 WESTAR XING STE 101
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-7815
Country	:	US
Telephone Number	:	614-508-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 WESTAR XING STE 101
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-7815
Country	:	US
Telephone Number	:	614-508-2223
Fax Number	:	614-508-2233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	01/27/2026

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Directions to “ AMANDA C JETT CPNP-PC” Practice Location

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