Provider Demographics
NPI:1649717786
Name:JARRELL HEALTHCARE LLC
Entity type:Organization
Organization Name:JARRELL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-219-5547
Mailing Address - Street 1:2621 HIBISCUS WAY
Mailing Address - Street 2:#125
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2776
Mailing Address - Country:US
Mailing Address - Phone:937-219-5547
Mailing Address - Fax:937-912-5449
Practice Address - Street 1:2621 HIBISCUS WAY
Practice Address - Street 2:#125
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2776
Practice Address - Country:US
Practice Address - Phone:937-219-5547
Practice Address - Fax:937-912-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty