Provider Demographics
NPI:1407735384
Name:CHESSON, JACKIE R (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:R
Last Name:CHESSON
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 BAIER AVE # 42A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2084
Mailing Address - Country:US
Mailing Address - Phone:816-419-1500
Mailing Address - Fax:
Practice Address - Street 1:167 BAIER AVE # 42A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2084
Practice Address - Country:US
Practice Address - Phone:816-419-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide