Individual provider · NPI-1

Kaydreyanna Jackson

Prosthetist · Mechanicsville, VA

NPI number1265314496
StatusActive
Last updated in NPPESJun 19, 2026

Details

NPI
1265314496
Entity type
Individual (NPI-1)
Name
Kaydreyanna Jackson
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 21, 2025
Certification date
Jun 19, 2026
Last updated
Jun 19, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
224P00000X Prosthetist1201132983VAYes

Practice location

7078 Mechanicsville Tpke
Mechanicsville, VA 23111-3629

Phone 804-803-2249

Mailing address

7078 Mechanicsville Tpke
Mechanicsville, VA 23111-3629

Phone 504-401-9955

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