Provider Demographics
NPI:1841963683
Name:ARNOLD, JENICA MARQUIS (CERTIFIED CAREGIVER)
Entity type:Individual
Prefix:MISS
First Name:JENICA
Middle Name:MARQUIS
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:CERTIFIED CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7732
Mailing Address - Country:US
Mailing Address - Phone:769-237-7742
Mailing Address - Fax:
Practice Address - Street 1:2115 MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7732
Practice Address - Country:US
Practice Address - Phone:769-237-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health