Provider Demographics
NPI:1952774085
Name:JONES, NIKAYA
Entity type:Individual
Prefix:
First Name:NIKAYA
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 WARSAW ST
Mailing Address - Street 2:PO.BOX 80542
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2363
Mailing Address - Country:US
Mailing Address - Phone:419-290-2177
Mailing Address - Fax:
Practice Address - Street 1:2830 WARSAW ST
Practice Address - Street 2:2520 MONROE ST
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2363
Practice Address - Country:US
Practice Address - Phone:419-290-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRU558035251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH484219659604Medicaid