MEDICARE: MRS. JACKELYN NICOLE RAY RN, BSN

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
1	163WS0200X	School Registered Nurse	749081	CA

General Provider Information

NPI Number	:	1639995897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACKELYN NICOLE RAY RN, BSN

Provider Business Mailing Address
First Line	:	5225 KELSO VALLEY RD
Second Line	:
City	:	WELDON
State	:	CA
Zip	:	93283-9564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 FAY RANCH RD
Second Line	:
City	:	WELDON
State	:	CA
Zip	:	93283-9735
Country	:	US
Telephone Number	:	760-378-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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