Provider Demographics
NPI:1649159161
Name:BRACKENRIDGE, JANIYA LASHAY
Entity type:Individual
Prefix:
First Name:JANIYA
Middle Name:LASHAY
Last Name:BRACKENRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 SE RIO DR APT 303
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3862
Mailing Address - Country:US
Mailing Address - Phone:678-593-8901
Mailing Address - Fax:
Practice Address - Street 1:2810 SE RIO DR APT 303
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-3862
Practice Address - Country:US
Practice Address - Phone:678-593-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility