MEDICARE: MS. VERNEEKY CARENDA JACKSON PERSONAL CARE AIDE

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	374U00000X	Home Health Aide		VA

General Provider Information

NPI Number	:	1720444839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERNEEKY CARENDA JACKSON PERSONAL CARE AIDE

Provider Business Mailing Address
First Line	:	4407 SPRENKLE LN APT C
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-3580
Country	:	US
Telephone Number	:	804-502-5897
Fax Number	:	804-501-5274

Provider Business Practice Location Address
First Line	:	8260 ATLEE ROAD
Second Line	:	BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2309
Country	:	US
Telephone Number	:	804-764-6000
Fax Number	:	804-764-6324

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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