Individual
KELLIE NICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13923 PAINTED BUNTING LN, RIVERVIEW, FL 33579-3525
(813) 304-8251
Mailing address
13923 PAINTED BUNTING LN, RIVERVIEW, FL 33579-3525
(813) 304-8251
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/11/2026
Last updated
04/11/2026
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