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NPI Code Detail

MEDICARE: JADA BLAKELY LPN

MEDICARE: JADA BLAKELY LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLPN.172416.MEDS-IVOH

General Provider Information

NPI Number : 1780214262
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADA BLAKELY LPN
Provider Business Mailing Address
First Line : 184 S HAMPTON RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1608
Country : US
Telephone Number : 614-942-9146
Fax Number :
Provider Business Practice Location Address
First Line : 184 S HAMPTON RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1608
Country : US
Telephone Number : 614-942-9146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2020
Last Update Date : 01/23/2020

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