Provider Demographics
NPI:1386409795
Name:JACKSON-KYLES, MAERAKLE PAIGE
Entity type:Individual
Prefix:
First Name:MAERAKLE
Middle Name:PAIGE
Last Name:JACKSON-KYLES
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 1:5912 THUNDER HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7916
Mailing Address - Country:US
Mailing Address - Phone:419-283-8266
Mailing Address - Fax:
Practice Address - Street 1:5912 THUNDER HOLLOW DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7916
Practice Address - Country:US
Practice Address - Phone:419-283-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty