Provider Demographics
NPI:1831475987
Name:ANDERSON, JESSIE SHERIDAN (CNP)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:SHERIDAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3329
Mailing Address - Country:US
Mailing Address - Phone:614-890-1914
Mailing Address - Fax:614-890-4988
Practice Address - Street 1:904 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3329
Practice Address - Country:US
Practice Address - Phone:614-890-1914
Practice Address - Fax:614-890-4988
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14310-NP363LW0102X
OH306073163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
12313522OtherCAQH