Individual ProviderKrista JacksonStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address809 82nd Pkwy, Myrtle Beach, SC 29572-4607(843) 692-3499PECOS EnrollmentBased on the most recent information from CMS, provider Krista Jackson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1326740960Provider TypeIndividualFull NameJackson, KristaGenderFemaleSole ProprietorNoEnumeration Date3/20/2023Last Updated3/20/2023Contact InformationPractice LocationPractice Address809 82nd Pkwy, Myrtle Beach, SC 29572-4607Phone(843) 692-3499FaxUnlisted FaxMailing LocationMailing Address809 82nd Pkwy, Myrtle Beach, SC 29572-4607PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer