Individual
DAMITA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1616 NE 81ST ST, KANSAS CITY, MO 64118-8245
(816) 783-7938
Mailing address
1616 NE 81ST ST, KANSAS CITY, MO 64118-8245
(816) 783-7938
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
189164
VA
376K00000X
Nurse's Aide
Primary
100018A
MO
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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