Provider Demographics
NPI:1881072973
Name:MYERS, STEPHANIE M (CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-9615
Mailing Address - Fax:614-293-3277
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-685-9615
Practice Address - Fax:614-293-3277
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.343359363LA2100X
OHAPRN.CNP.17703363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01686426OtherRAILROAD MEDICARE
OH0141870Medicaid
OHP01686426OtherRAILROAD MEDICARE
OHH415430Medicare PIN