Provider Demographics
NPI:1588404917
Name:MCCREERY, JIMMIE DALE
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:DALE
Last Name:MCCREERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 HIDDEN SPRING LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8457
Mailing Address - Country:US
Mailing Address - Phone:330-328-4792
Mailing Address - Fax:
Practice Address - Street 1:2666 HIDDEN SPRING LN
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8457
Practice Address - Country:US
Practice Address - Phone:330-328-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty