Jackson, Jacquenett
Jackson, Jacquenett is an sole proprietor health care provider with primary practice located at 114 Second Street , Shubuta MS 39360. She recently has only one registered license in Nursing & Custodial Care Facilities / Adult Care Home, which is considered as her primary health care specialty. Jackson, Jacquenett can be contacted via phone (601) 687-1128.Contact Information
Primary practice address
114 Second Street
Shubuta MS 39360
Phone: (601) 687-1128
Fax: (601) 687-5497
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Adult Care Home | 311ZA0620X |
Profile Details
| NPI number | 1376727388 |
|---|---|
| LBN Legal business name | Jackson, Jacquenett |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 27th, 2007 |
| Last updated | Dec 27th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376727388 | NPPES |
| Mississippi | MEDICAID | 00770581 |
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