Active NPI
Jessica Renee Bledsoe
- Nurse Practitioner
- Beavercreek, OH
National Provider Identifier
1295295657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- LE-00027770
- Practice address
- 75 Sylvania Dr
Beavercreek, OH 45440-3237 - Phone
- (937) 320-5050
- NPI assigned
- Mar 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | LE-00027770 | OH | Primary |
Addresses
Primary practice location
75 Sylvania Dr
Beavercreek, OH 45440-3237
Mailing address
75 Sylvania Dr
Beavercreek, OH 45440-3237
Phone (937) 320-5050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LE-00027770 | OH | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553126400000",
"number": "1295295657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 SYLVANIA DR",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454403237",
"telephone_number": "937-320-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 SYLVANIA DR",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454403237",
"telephone_number": "937-320-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLEDSOE",
"first_name": "JESSICA",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-21",
"last_updated": "2019-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "LE-00027770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beavercreek, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.