Provider Demographics
NPI:1184275083
Name:BARROWS, JACKIE LYNN (CNA)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:BARROWS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 STATE HIGHWAY 220
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-4306
Mailing Address - Country:US
Mailing Address - Phone:607-316-8195
Mailing Address - Fax:
Practice Address - Street 1:4161 STATE HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-4306
Practice Address - Country:US
Practice Address - Phone:607-316-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79882576171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY811842857OtherNY STATE