Provider Demographics
NPI:1437813722
Name:STEVENS, JACKI LYNN
Entity Type:Individual
Prefix:MRS
First Name:JACKI
Middle Name:LYNN
Last Name:STEVENS
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 1:9806 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9643
Mailing Address - Country:US
Mailing Address - Phone:614-915-6445
Mailing Address - Fax:
Practice Address - Street 1:9806 MERRY LN
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9643
Practice Address - Country:US
Practice Address - Phone:614-915-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide