Provider Demographics
NPI:1780566406
Name:JACKSON, CIARA SHEREE
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:SHEREE
Last Name:JACKSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 CASSELL DR APT 104
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1666
Mailing Address - Country:US
Mailing Address - Phone:910-689-6953
Mailing Address - Fax:
Practice Address - Street 1:616 CASSELL DR APT 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1666
Practice Address - Country:US
Practice Address - Phone:910-689-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC577988376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide