Healthcare Provider Details

I. General information

NPI: 1982420444
Provider Name (Legal Business Name): JADA RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 RAILROAD ST
JACKSON KY
41339-7364
US

IV. Provider business mailing address

610 RAILROAD ST
JACKSON KY
41339-7364
US

V. Phone/Fax

Practice location:
  • Phone: 606-568-3622
  • Fax:
Mailing address:
  • Phone: 606-568-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: