Basic Information
| Provider Information | |||||||||
| NPI: | 1255679742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANNUCCI | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 E THOMASON CIR | ||||||||
| Address2: | |||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347490390 | ||||||||
| FaxNumber: | 3347429165 | ||||||||
| Practice Location | |||||||||
| Address1: | 8020 LIBERTY WAY | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450692519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134634300 | ||||||||
| FaxNumber: | 5134634310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 13717 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SF0001X | 1-172548 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 363LF0000X | CNP.13717 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0080076 | 05 | OH | MEDICAID | 2565399 | 05 | OH | MEDICAID |