Provider Demographics
NPI:1891378154
Name:JACO, MARKYA JORDAINE
Entity Type:Individual
Prefix:
First Name:MARKYA
Middle Name:JORDAINE
Last Name:JACO
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 1:216 OLD HIGHWAY 63 N APT 20
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6377
Mailing Address - Country:US
Mailing Address - Phone:573-808-7530
Mailing Address - Fax:
Practice Address - Street 1:216 OLD HIGHWAY 63 N APT 20
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6377
Practice Address - Country:US
Practice Address - Phone:573-808-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide