Individual
MRS. JACQUELYN MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1609 HIWAY 41, MT PLEASANT, SC 29464
(843) 870-1839
Mailing address
PO BOX 2522, MT PLEASANT, SC 29464
(843) 870-1839
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
120514E
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
Primary
120514E
—
Other
Enumeration date
12/31/2007
Last updated
12/31/2007
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