Healthcare Provider Details

I. General information

NPI: 1386409795
Provider Name (Legal Business Name): MAERAKLE PAIGE JACKSON-KYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 THUNDER HOLLOW DR
TOLEDO OH
43615-7916
US

IV. Provider business mailing address

5912 THUNDER HOLLOW DR
TOLEDO OH
43615-7916
US

V. Phone/Fax

Practice location:
  • Phone: 419-283-8266
  • Fax:
Mailing address:
  • Phone: 419-283-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: