Chanel Jackson, STNA

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

400702651207 Issued in OH

Practice address

93 W Glendale St
Bedford, OH 44146-3273

Phone

(216) 855-2969

NPI assigned

Dec 11, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481414400000",
    "number": "1659815637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 W GLENDALE ST",
            "city": "BEDFORD",
            "state": "OH",
            "postal_code": "441463273",
            "telephone_number": "216-855-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 W GLENDALE ST",
            "city": "BEDFORD",
            "state": "OH",
            "postal_code": "441463273",
            "telephone_number": "216-855-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHANEL",
        "credential": "STNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-11",
        "last_updated": "2016-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "OH",
            "license": "400702651207",
            "primary": true
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "OH",
            "license": "400702651207",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Uche G Iheme, M.D.
• Integrated Health Services Management
• Internal Medicine Group Inc
• Isalon Plus LLC
• King Jerahmeel N Ben Israel
• Kathleen Jackson
• William Jackson Jr.
• Diane Marie Jacobs, RN
• Kelli Marie Jacobs, LMT
• Harvey M Jaffe, D.D.S.

• Home Health Aide in Bedford, OH
• Providers in Bedford, OH by specialty
• Home Health Aide in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.