Jackson, Mishi Kavon
Jackson, Mishi Kavon is an individual health care provider with primary practice located at 1471 Jag Branch Blvd Unit 103 , Kernersville NC 27284-6963. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jackson, Mishi Kavon can be contacted via phone (336) 515-7410.Contact Information
Primary practice address
1471 Jag Branch Blvd Unit 103
Kernersville NC 27284-6963
Phone: (336) 515-7410
Fax: (336) 515-7419
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 200600012 | North Carolina |
Profile Details
| NPI number | 1215006192 |
|---|---|
| LBN Legal business name | Jackson, Mishi Kavon |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 7th, 2006 |
| Last updated | Mar 7th, 2023 - about last year |
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 | 1215006192 | NPPES |
| North Carolina | Other | 42515 | PARTNERS MEDICARE |
| North Carolina | MEDICAID | 5904650 | PARTNERS MEDICARE |
| North Carolina | Other | 187165 | PARTNERS MEDICARE |
| North Carolina | Other | 141YE | PARTNERS MEDICARE |
| North Carolina | Other | P00650299 | PARTNERS MEDICARE |
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