MRS. JACQUENETT JACKSON
NPI 1376727388
Custodial Care Facility - Adult Care Home in Shubuta, MS

Q: What is Jacquenett Jackson's NPI number?

The NPI number for Jacquenett Jackson is 1376727388. It was assigned to this individual provider in the NPPES registry on December 27, 2007. The provider is also known as Annette Smith.

Q: What is Jacquenett Jackson's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Active since December 27, 2007

114 SECOND STREET, SHUBUTA, MS 39360(601) 687-1128(601) 687-5497 Get Directions Write a Review

NPPES record last updated: December 27, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Mrs. Jacquenett Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. JACQUENETT JACKSON (NPI 1376727388) is an individual adult care home provider in Shubuta, Mississippi and active in the NPI registry since December 2007.

NPPES Registry Identity

NPI1376727388

Entity TypeIndividualFemale

Primary Taxonomy311ZA0620X

Provider Legal NameMRS. JACQUENETT JACKSON

Location Address114 SECOND STREETShubuta, MS 39360

Mailing AddressPo Box 462Shubuta, MS 39360-0462 · (601) 687-1128 · Fax (601) 687-5497

Phone(601) 687-1128

Fax(601) 687-5497

Sole ProprietorYes

Enumeration DateDecember 27, 2007

✔ NPI 1376727388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities

Taxonomy Code311ZA0620X

Definition

A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

114 SECOND STREET, Shubuta, MS 39360

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Other Names 1

Other Name (5)Annette Smith

Other Identifiers 1

Medicaid00770581MS

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacquenett Jackson's NPI number?

The NPI number for Jacquenett Jackson is 1376727388. It was assigned to this individual provider in the NPPES registry on December 27, 2007. The provider is also known as Annette Smith.

Where is Jacquenett Jackson located?

Jacquenett Jackson practices at 114 Second Street, Shubuta, MS 39360. The listed phone number is (601) 687-1128.

What is Jacquenett Jackson's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Jacquenett Jackson was last updated on December 27, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.