Provider Demographics
NPI:1487925194
Name:BODENBACH, JAYNE (APRN)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:BODENBACH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:606 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1095
Practice Address - Country:US
Practice Address - Phone:859-331-3353
Practice Address - Fax:859-331-3326
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007296363L00000X
OHAPRN.CNP.15823363LA2200X
IN71013618A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060635Medicaid
KY7100201450Medicaid
KY7100201450Medicaid