Individual ProviderBeverly Yvonne JacksonRegistered NurseNursing Service ProvidersPractice Address4212 N 16th St, Phoenix, AZ 85016-5319(602) 263-1200PECOS EnrollmentBased on the most recent information from CMS, provider Beverly Yvonne Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1477814424Provider TypeIndividualFull NameJackson, Beverly YvonneCredentialRN, MSNGenderFemaleSole ProprietorNoEnumeration Date6/6/2012Last Updated6/6/2012Contact InformationPractice LocationPractice Address4212 N 16th St, Phoenix, AZ 85016-5319Phone(602) 263-1200Fax(602) 200-5383Mailing LocationMailing AddressP O Box 31001-0698, Pasadena, CA 85016Phone(602) 263-1200Fax(602) 200-5383Provider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense684872California