Healthcare Provider Details

I. General information

NPI: 1891604617
Provider Name (Legal Business Name): JAKHIA TRAYLOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

15 JILL DR
PRINCETON KY
42445-1828
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4019763
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: