Individual
MS. IKISHIA N JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N
Contact information
Practice address
625 E GIRARD AVE APT 1, PHILADELPHIA, PA 19125-3400
(267) 439-0966
(215) 425-4414
Mailing address
625 E GIRARD AVE APT 1, PHILADELPHIA, PA 19125-3400
(267) 439-0966
(215) 425-4414
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
06650501
PA
163WH0200X
Home Health Registered Nurse
06650501
PA
251B00000X
Case Management Agency
06650501
PA
251E00000X
Home Health Agency
06650501
PA
251E00000X
Home Health Agency
Primary
652238
PA
282J00000X
Religious Nonmedical Health Care Institution
06650501
PA
343900000X
Non-emergency Medical Transport (VAN)
06650501
PA
374U00000X
Home Health Aide
06650501
PA
376J00000X
Homemaker
06650501
PA
385H00000X
Respite Care
06650501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103310350-001
—
PA
Enumeration date
06/14/2016
Last updated
07/27/2021
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