Shynetra Jackson

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

$$$$$$$$$ Issued in FL

Practice address

4679 Marcos Cir
Kissimmee, FL 34758-2743

Phone

(407) 259-6984

NPI assigned

Mar 22, 2024

Last updated

Mar 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Psychiatric/Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1255181442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4679 MARCOS CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347582743",
            "telephone_number": "407-259-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4679 MARCOS CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347582743",
            "telephone_number": "407-259-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHYNETRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11031964",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "$$$$$$$$$",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Otavia Jack
• Pamela D Jackman, M.S CCC-SLP
• Bailey Jackson
• Billy Jackson
• Maureen Ann Jackson, PHARM. D
• Brooke Jacobs, OTR/L, OTD
• Karen Jacobs, ARNP
• Jennifer Jacques Lalanne, APRN
• Jeangardy Jacquet
• Susan H. Jacquot, D.D.S.

• Psychiatric/Mental Health Nurse Practitioner in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.