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General NPI Number Information
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NPI Number | 1699615989
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Entity Type | Individual
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Provider Name | MS. JACKIE RENEE DOUGLAS
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Gender | Female
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 6544 N 34TH ST
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City | OMAHA
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State | NE
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Zip | 68112-3024
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Country | US
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Telephone | 531-284-6210
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Fax |
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Provider Business Mailing Address
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Address Line | 6403 N 62ND AVE
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City | OMAHA
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State | NE
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Zip | 68104-1106
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Country | US
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Telephone | 402-812-6115
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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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