Individual
KENA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 W 7TH ST APT 1, JACKSONVILLE, FL 32209-7924
(904) 635-0223
Mailing address
1211 W 7TH ST APT 1, JACKSONVILLE, FL 32209-7924
(904) 635-0223
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HOMEMAKER
HOME CARE
—
Enumeration date
02/11/2021
Last updated
02/11/2021
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