Individual
SHELITA RENEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2420 AVALON DR, LOUISVILLE, KY 40216-1738
(502) 644-0002
(502) 644-0002
Mailing address
2420 AVALON DR, LOUISVILLE, KY 40216-1738
(502) 644-0002
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
50203414
KY
Other
Enumeration date
07/09/2025
Last updated
07/09/2025
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