Provider Demographics
NPI:1699080861
Name:BOAL, JESSICA KAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KAYE
Last Name:BOAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 STATE ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:KILLBUCK
Mailing Address - State:OH
Mailing Address - Zip Code:44637-9746
Mailing Address - Country:US
Mailing Address - Phone:330-276-9930
Mailing Address - Fax:
Practice Address - Street 1:7529 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9796
Practice Address - Country:US
Practice Address - Phone:740-415-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN343915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse