NPIMap

Organization Active NPI

Jackie Ezell

  • Community Health Worker
  • Youngstown, OH
National Provider Identifier
1801201314
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
JACKIE EZELL
Practice address
516 Griffith St Unit 401
Youngstown, OH 44510-2604
Phone
(330) 787-5754
NPI assigned
Jun 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jackie Denese Ezell
Title
Independent Provider
Phone
330787575431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 172V00000X Primary

Addresses

Primary practice location

516 Griffith St Unit 401
Youngstown, OH 44510-2604

Mailing address

516 Griffith St Unit 401
Youngstown, OH 44510-2604
Phone (330) 787-5754

Other identifiers 1

IdentifierTypeStateIssuer
2858760MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1801201314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 GRIFFITH ST UNIT 401",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445102604",
            "telephone_number": "330-787-5754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 GRIFFITH ST UNIT 401",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445102604",
            "telephone_number": "330-787-5754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE EZELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "EZELL",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "DENESE",
        "authorized_official_title_or_position": "INDEPENDENT PROVIDER",
        "authorized_official_telephone_number": "330787575431"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2858760",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.