Provider Demographics
NPI:1205609138
Name:RADFORD, JAYLA NICOLE
Entity type:Individual
Prefix:MS
First Name:JAYLA
Middle Name:NICOLE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAYLA
Other - Middle Name:NICOLE
Other - Last Name:RADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26851 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3144
Mailing Address - Country:US
Mailing Address - Phone:734-680-2865
Mailing Address - Fax:
Practice Address - Street 1:26851 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3144
Practice Address - Country:US
Practice Address - Phone:734-680-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide