Provider Demographics
NPI:1326780990
Name:SMITH, JAKEENA SHAVON
Entity Type:Individual
Prefix:
First Name:JAKEENA
Middle Name:SHAVON
Last Name:SMITH
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 1:818 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3226
Mailing Address - Country:US
Mailing Address - Phone:856-238-2385
Mailing Address - Fax:
Practice Address - Street 1:818 E PARK AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3226
Practice Address - Country:US
Practice Address - Phone:856-238-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty