Healthcare Provider Details

I. General information

NPI: 1225854656
Provider Name (Legal Business Name): CIERRA ELIZABETH JEMISON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CIERRA ELIZABETH MATTHEWS

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 SHANNON DR APT 209
CROSS LANES WV
25313-1556
US

IV. Provider business mailing address

5102 SHANNON DR APT 209
CROSS LANES WV
25313-1556
US

V. Phone/Fax

Practice location:
  • Phone: 681-214-2313
  • Fax:
Mailing address:
  • Phone: 681-214-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number106279
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: