Provider Demographics
NPI:1164096855
Name:JELKS, ASHLEY RESHAE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RESHAE
Last Name:JELKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 GREENWOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2469
Mailing Address - Country:US
Mailing Address - Phone:567-315-3788
Mailing Address - Fax:
Practice Address - Street 1:712 MORAN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2800
Practice Address - Country:US
Practice Address - Phone:419-984-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty