=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023858750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN K JACKSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 05/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 BRANCH HILL CT
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45030-9763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-304-3393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 82 BRANCH HILL CT
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45030-9763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-304-3393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------