Provider Demographics
NPI:1952639791
Name:TOOMBS, JACKEY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JACKEY
Middle Name:LYNN
Last Name:TOOMBS
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 1:234 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1716
Mailing Address - Country:US
Mailing Address - Phone:315-656-8123
Mailing Address - Fax:
Practice Address - Street 1:234 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116-1716
Practice Address - Country:US
Practice Address - Phone:315-656-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287945-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse