Provider Demographics
NPI:1558695940
Name:JACKSON-PRIDE, KASHIKA KENWELLA (DOULA)
Entity Type:Individual
Prefix:MS
First Name:KASHIKA
Middle Name:KENWELLA
Last Name:JACKSON-PRIDE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6454 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-6207
Mailing Address - Country:US
Mailing Address - Phone:727-501-3748
Mailing Address - Fax:
Practice Address - Street 1:6454 28TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6207
Practice Address - Country:US
Practice Address - Phone:727-501-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5940374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula