Provider Demographics
NPI:1750122933
Name:JACKSON, SHERRI LEE
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LEE
Last Name:JACKSON
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 1:2600 LINK SIDE DR APT 6
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2962
Mailing Address - Country:US
Mailing Address - Phone:513-375-7970
Mailing Address - Fax:
Practice Address - Street 1:4893 RIVERCREST DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-8564
Practice Address - Country:US
Practice Address - Phone:513-364-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide