Individual
JACKIE LYN KAYNE-SHERAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PEER SUPPORT
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA137433G
DRIVERS LICENSE
ID
Enumeration date
06/18/2020
Last updated
06/18/2020
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