Provider Demographics
NPI:1306269881
Name:MCCOMBS, JAMEKA A (RN)
Entity type:Individual
Prefix:MS
First Name:JAMEKA
Middle Name:A
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2312 FAR HILLS AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1512
Mailing Address - Country:US
Mailing Address - Phone:937-668-9678
Mailing Address - Fax:937-867-5417
Practice Address - Street 1:2312 FAR HILLS AVE STE 113
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-1512
Practice Address - Country:US
Practice Address - Phone:937-668-9678
Practice Address - Fax:937-867-5417
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1171335163W00000X
WV106816163W00000X
IN28257156A163W00000X
GALPN078779164W00000X
OHPN129762164W00000X
OHRN.437408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1306269881Medicaid