Provider Demographics
NPI:1366100265
Name:CARDEN, JAZZLYN KALEI
Entity type:Individual
Prefix:
First Name:JAZZLYN
Middle Name:KALEI
Last Name:CARDEN
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 1:230 BOONES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:WV
Mailing Address - Zip Code:24938-7071
Mailing Address - Country:US
Mailing Address - Phone:304-956-0718
Mailing Address - Fax:
Practice Address - Street 1:230 BOONES MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:WV
Practice Address - Zip Code:24938-7071
Practice Address - Country:US
Practice Address - Phone:304-956-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant