Provider Demographics
NPI:1427271188
Name:JACKSON, KIMBERLY SCHERIE (RN)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SCHERIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3741
Mailing Address - Country:US
Mailing Address - Phone:216-701-7729
Mailing Address - Fax:
Practice Address - Street 1:1285 E 113TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3741
Practice Address - Country:US
Practice Address - Phone:216-701-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 312293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse