Provider Demographics
NPI:1598806994
Name:LYKES, JENNIFER ELLEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:LYKES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2126
Mailing Address - Country:US
Mailing Address - Phone:937-559-3886
Mailing Address - Fax:
Practice Address - Street 1:611 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2126
Practice Address - Country:US
Practice Address - Phone:937-559-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1407781.MEDS.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2320545Medicaid