Avis Shantrell Jackson

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

1700 NW 66TH St
Miami, FL 33147-7444

Phone

(786) 333-4557

NPI assigned

Dec 20, 2019

Last updated

Dec 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1861030835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW 66TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331477444",
            "telephone_number": "786-333-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NW 66TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331477444",
            "telephone_number": "786-333-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AVIS",
        "middle_name": "SHANTRELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Preferred Care LLC
• Jackson Rehab Operations LLC.
• Jackson South Community Hospital
• Andrea Jasmine Jackson
• Austin Jackson, DMD
• Brenda Ann Jackson
• Georgiana Jackson
• James John Jackson, MS,OTR,CHT
• Jeffrey Lamar Jackson II, DC
• Jennifer Jackson, M.D.

• Home Health Aide in Miami, FL
• Providers in Miami, FL by specialty
• Home Health Aide in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.