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NPI Code Detail

MEDICARE: JAKISTA WINGATE

MEDICARE: JAKISTA WINGATE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1366304149
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKISTA WINGATE
Provider Business Mailing Address
First Line : 474 N YELLOW SPRINGS ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45504-2463
Country : US
Telephone Number : 937-399-9500
Fax Number :
Provider Business Practice Location Address
First Line : 474 N YELLOW SPRINGS ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45504-2463
Country : US
Telephone Number : 937-399-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ JAKISTA WINGATE ” Practice Location

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