Healthcare Provider Details
I. General information
NPI: 1932525581
Provider Name (Legal Business Name): VELLETTA ANN JACKSON RN, MSN, CRRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
611 PINE AVE
ALBANY GA
31701-2403
US
IV. Provider business mailing address
2303 E ALBERSON DR
ALBANY GA
31721-2045
US
V. Phone/Fax
- Phone: 229-288-3879
- Fax:
- Phone: 229-288-3879
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133NN1002X |
| Taxonomy | Nutrition Education Nutritionist |
| License Number | 108011 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0807X |
| Taxonomy | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0809X |
| Taxonomy | Adult Psychiatric/Mental Health Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR0400X |
| Taxonomy | Rehabilitation Registered Nurse |
| License Number | 108011 |
| License Number State | GA |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376G00000X |
| Taxonomy | Nursing Home Administrator |
| License Number | 108011 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
