Provider Demographics
NPI:1841053113
Name:JACKSON-ANDERSON, KIAERRA RENEE (HOME CARE)
Entity type:Individual
Prefix:
First Name:KIAERRA
Middle Name:RENEE
Last Name:JACKSON-ANDERSON
Suffix:
Gender:F
Credentials:HOME CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15512 DENBY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3928
Mailing Address - Country:US
Mailing Address - Phone:313-283-2051
Mailing Address - Fax:
Practice Address - Street 1:15512 DENBY
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3928
Practice Address - Country:US
Practice Address - Phone:313-283-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker