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NPI Code Detail

MEDICARE: MR. JACSUN JAIMS KELLOGG PMHCNS

MEDICARE: MR. JACSUN JAIMS KELLOGG PMHCNS
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
1364S00000XClinical Nurse SpecialistAPRN.CNS.10466OH

General Provider Information

NPI Number : 1992950414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACSUN JAIMS KELLOGG PMHCNS
Provider Business Mailing Address
First Line : 1 PERKINS SQ
Second Line :
City : AKRON
State : OH
Zip : 44308-1063
Country : US
Telephone Number : 330-543-3332
Fax Number :
Provider Business Practice Location Address
First Line : 26600 RENAISSANCE PKWY
Second Line :
City : WARRENSVILLE HEIGHTS
State : OH
Zip : 44128-5795
Country : US
Telephone Number : 216-352-1620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2008
Last Update Date : 05/18/2026

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