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General NPI Number Information
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NPI Number | 1336826213
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Entity Type | Individual
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Provider Name | NECHELLE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 1312 JENNIE SCHER RD
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City | RICHMOND
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State | VA
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Zip | 23231-1010
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Country | US
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Telephone | 804-591-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3671
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Country | US
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Telephone | 757-204-2691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | VA
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