Jacqueline Whitaker Bandy
Individual provider Active NPI Home Health Agency · Rocky Mount, NC
NPI 1043350812 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1043350812
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Agency 251E00000X
- License
- HC3572 (NC)
- Practice address
- 3072 Sunset Ave # B
Rocky Mount, NC 27804-3647 - Phone
- (252) 443-4276
- Fax
- (252) 443-4014
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HC3572 | NC | MD | Home Health Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HC3572 | NC | Yes |
Addresses
Primary practice location
3072 Sunset Ave # B
Rocky Mount, NC 27804-3647
Mailing address
1260 Fairway Ter
Rocky Mount, NC 27804-9618
Phone (252) 443-4276
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6601597 | Medicaid | NC |
Other providers in Rocky Mount, NC
- Harold A Bailey
- Susan L Baker
- Amanda Nash Baldwin
- Donald W Bales
- Vasanth B Baliga
- Chelsea Banks
- Faraja F Barbour
- Garrett Barger
- Shawanda Ann Barnes
- Lamont Zebediah Barnett
All providers in Rocky Mount, NC · Home Health Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.