Provider Demographics
NPI:1558682484
Name:STEVENS, JESSICA ERIN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 REED RD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-457-2306
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED RD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-457-2306
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164659390200000X
OH35-123398207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01338258OtherRAILROAD MEDICARE
OH0104322Medicaid
OHH327230Medicare PIN