Provider Demographics
NPI:1902255169
Name:JAKEWAY, KRISTY JO (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:JO
Last Name:JAKEWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KRISTY
Other - Middle Name:JO
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11376 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OH
Mailing Address - Zip Code:43331
Mailing Address - Country:US
Mailing Address - Phone:937-869-8081
Mailing Address - Fax:
Practice Address - Street 1:11376 OAK ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OH
Practice Address - Zip Code:43331-9293
Practice Address - Country:US
Practice Address - Phone:937-869-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019397363LF0000X
OHRN366667163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency