Healthcare Provider Details

I. General information

NPI: 1689367161
Provider Name (Legal Business Name): JAYDE MAGEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAYDE KNOERR APRN

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 11/15/2024
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S. BURNETT RD
SPRINGFIELD OH
45505
US

IV. Provider business mailing address

435 S. BURNETT RD
SPRINGFIELD OH
45505
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-8796
  • Fax: 937-325-6698
Mailing address:
  • Phone: 937-325-8796
  • Fax: 937-325-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0033611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: