Provider Demographics
NPI:1902111727
Name:BAIR, DOROTHY JACKSON (CNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JACKSON
Last Name:BAIR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5131 BEACON HILL RD STE 220C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4442
Practice Address - Country:US
Practice Address - Phone:614-544-2832
Practice Address - Fax:614-544-8778
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11693-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3091050Medicaid
OHNP38032Medicare PIN