Healthcare Provider Details

I. General information

NPI: 1861112492
Provider Name (Legal Business Name): KALIYAH MICHELLE JAYNES RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N CORONADO ST APT 2116
CHANDLER AZ
85224-7321
US

IV. Provider business mailing address

700 N CORONADO ST APT 2116
CHANDLER AZ
85224-7321
US

V. Phone/Fax

Practice location:
  • Phone: 480-553-2678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number218641
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: