Provider Demographics
NPI:1962040394
Name:DAYTON, JESSICA (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DAYTON
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 1:6413 THORNBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7821
Mailing Address - Country:US
Mailing Address - Phone:513-770-0787
Mailing Address - Fax:513-770-0144
Practice Address - Street 1:6413 THORNBERRY CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7821
Practice Address - Country:US
Practice Address - Phone:513-770-0787
Practice Address - Fax:513-770-0144
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374079163W00000X
KY3016094363LF0000X
OHAPRN.CNP.025762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100733780Medicaid