Healthcare Provider Details

I. General information

NPI: 1336559756
Provider Name (Legal Business Name): JACQUELINE DAVIS ANDERSON NURSE TECH II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE DAVIS ANDERSON NURSE TECH II

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 01/25/2026
Certification Date: 01/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E DIXIE DR UNIT E
ASHEBORO NC
27203-8809
US

IV. Provider business mailing address

PO BOX 36053
GREENSBORO NC
27416-6053
US

V. Phone/Fax

Practice location:
  • Phone: 336-677-5652
  • Fax:
Mailing address:
  • Phone: 336-340-3845
  • Fax: 336-851-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number86656
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number86656
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number86656
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: