Provider Demographics
NPI:1881388635
Name:JACKSON, CANDES RENEE (CNA, CMA)
Entity type:Individual
Prefix:
First Name:CANDES
Middle Name:RENEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CNA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 HIGHLAND VILLAGE DR # 221
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2487
Mailing Address - Country:US
Mailing Address - Phone:214-541-7515
Mailing Address - Fax:
Practice Address - Street 1:221 HIGHLAND VILLAGE DR # 221
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2487
Practice Address - Country:US
Practice Address - Phone:214-541-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X, 374U00000X, 174200000X, 251E00000X, 332U00000X, 372500000X, 372600000X, 104100000X, 171W00000X
TXNA0008761095376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171W00000XOther Service ProvidersContractor