Provider Demographics
NPI:1235575390
Name:PRICE, DUSTY M (CNP)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-5123
Mailing Address - Fax:614-293-4890
Practice Address - Street 1:6515 PULLMAN DR FL 2
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7380
Practice Address - Country:US
Practice Address - Phone:614-293-5123
Practice Address - Fax:614-293-4890
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA14596NP363L00000X
OHCOA.14596-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110979Medicaid