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General NPI Number Information
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NPI Number | 1497549539
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Entity Type | Individual
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Provider Name | NIA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 04/05/2025
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 11362 LINCOLNSHIRE DR
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City | CINCINNATI
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State | OH
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Zip | 45240-2339
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Country | US
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Telephone | 513-714-8661
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Fax |
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Provider Business Mailing Address
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Address Line | 11362 LINCOLNSHIRE DR
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City | CINCINNATI
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State | OH
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Zip | 45240-2339
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Country | US
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Telephone |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 4028764
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 601635180523
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License Number State | OH
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