Provider Demographics
NPI:1609178755
Name:LANHAM, JACLYN A (NP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:LANHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4206
Mailing Address - Country:US
Mailing Address - Phone:720-902-9298
Mailing Address - Fax:330-305-2878
Practice Address - Street 1:20 S 3RD ST STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4206
Practice Address - Country:US
Practice Address - Phone:720-902-9298
Practice Address - Fax:330-305-2878
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11881NP363LF0000X
OHCNP.11881363LP0808X
OHAPRN.CNP.11881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily