Provider Demographics
NPI:1033426044
Name:BIRDSELL, JENNA L (APRN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:BIRDSELL
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 1:651 SOUTH LIMESTONE STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505
Mailing Address - Country:US
Mailing Address - Phone:937-324-1111
Mailing Address - Fax:937-525-4541
Practice Address - Street 1:15 BISHOP DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2275
Practice Address - Country:US
Practice Address - Phone:614-392-5933
Practice Address - Fax:614-474-1515
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11694NP363LP0200X
OHAPRN.CNS.11758364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3134147Medicaid