Healthcare Provider Details

I. General information

NPI: 1710311816
Provider Name (Legal Business Name): MISS JASMYNE NICHOLE KIRKSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 S FREEDOM AVE
ALLIANCE OH
44601-5111
US

IV. Provider business mailing address

2339 S FREEDOM AVE
ALLIANCE OH
44601-5111
US

V. Phone/Fax

Practice location:
  • Phone: 330-323-0860
  • Fax:
Mailing address:
  • Phone: 330-323-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401546520713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: