Provider Demographics
NPI:1275155673
Name:CLEMIS ZACKERY, JAMIKA (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:JAMIKA
Middle Name:
Last Name:CLEMIS ZACKERY
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450616
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0611
Mailing Address - Country:US
Mailing Address - Phone:216-280-1511
Mailing Address - Fax:
Practice Address - Street 1:27676 WESTCHESTER PKWY APT F
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1219
Practice Address - Country:US
Practice Address - Phone:216-280-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide