| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JACKIE SMITH SIDES | 1710613757 | 2022-07-30 |
Jackie Smith Sides is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1710613757. Registration indicates Jackie Smith Sides is a provider of services with a specialization in Nursing Service Providers, Licensed Practical Nurse (Licensed Practical Nurse, ) (Licensed Practical Nurse, Nursing Service Providers)
| Entity Type | Individual |
| Provider Name | Jackie Smith Sides |
| Practice Office Address | 1408 E FRANKLIN ST MONROE, NC US |
| Practice Office Telephone | 7046252080 |
| Mailing Address | 201 WILKES DR APT C7 MONROE, NC 281102731 US |
| Business Telephone | 7044655348 |
| Code | Practice | License No State |
|---|---|---|
| 164W00000X PRIMARY | Nursing Service Providers Licensed Practical Nurse Licensed Practical Nurse Licensed Practical Nurse Nursing Service Providers | 71366
NC |