| NPI | 1992661573 |
|---|---|
| Former Name | JACKIE R FANNIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2025-12-30 |