MEDICARE: BETRECE JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1033040894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETRECE JACKSON

Provider Business Mailing Address
First Line	:	1234 SOUTHERN AVE SE APT 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4620
Country	:	US
Telephone Number	:	202-594-5125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 SOUTHERN AVE SE APT 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4620
Country	:	US
Telephone Number	:	202-594-5125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ BETRECE JACKSON ” Practice Location

Language	Start Address	Practice Location

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