Provider Demographics
NPI:1598356784
Name:BETT, JACKLINE CHEROP
Entity type:Individual
Prefix:
First Name:JACKLINE
Middle Name:CHEROP
Last Name:BETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 KISSIMMEE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5464
Mailing Address - Country:US
Mailing Address - Phone:214-757-9399
Mailing Address - Fax:
Practice Address - Street 1:802 117TH ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-3906
Practice Address - Country:US
Practice Address - Phone:214-757-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61071001163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health