Provider Demographics
NPI:1093355067
Name:SLONE, JACQUELINE RENEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:SLONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RENEE
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:513-718-2260
Mailing Address - Fax:
Practice Address - Street 1:262 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1309
Practice Address - Country:US
Practice Address - Phone:513-718-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015306363LF0000X
OHAPRN.CNP.025352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.025352OtherOH LICENSE
KY3015306OtherKY LICENSE
F06192861OtherAANP