Provider Demographics
NPI:1730777822
Name:KROSKY, JAMIE R
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:KROSKY
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 1:437 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1024
Mailing Address - Country:US
Mailing Address - Phone:330-383-2546
Mailing Address - Fax:
Practice Address - Street 1:437 N ELM ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1024
Practice Address - Country:US
Practice Address - Phone:330-383-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide