Provider Demographics
NPI:1245769033
Name:SOTHARD, JESSAMINE (NP)
Entity Type:Individual
Prefix:
First Name:JESSAMINE
Middle Name:
Last Name:SOTHARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSAMINE
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2640
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-245-7100
Practice Address - Fax:937-245-7999
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner