Provider Demographics
NPI:1720318181
Name:COAKLEY, JENNIFER MEGAN (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MEGAN
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1418
Mailing Address - Country:US
Mailing Address - Phone:740-380-3974
Mailing Address - Fax:
Practice Address - Street 1:143 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1418
Practice Address - Country:US
Practice Address - Phone:740-380-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN317987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse