Provider Demographics
NPI:1861901829
Name:KIRKPATRICK, JADE RESHEA (CNP)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:RESHEA
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-6942
Mailing Address - Fax:740-356-1264
Practice Address - Street 1:1711 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-8772
Practice Address - Fax:740-356-1264
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OHAPRN.CNP.022360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A