Shana Lorene Cox Jackson, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

25500 Issued in SC

Practice address

206 Centre South Blvd
Aiken, SC 29803-6319

Phone

(803) 642-9204

NPI assigned

Oct 4, 2020

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Southern Medical Management, LLC

  • Pediatrics Physician
  • Lexington, SC
  • NPI 1114196557
  NPD (past)
• Sweetgrass Pediatrics

  • Pediatrics Physician
  • North Charleston, SC
  • NPI 1437168135
  NPD (past)

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

{
    "created_epoch": "1601769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1730786641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 CENTRE SOUTH BLVD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298036319",
            "telephone_number": "803-642-9204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 CENTRE SOUTH BLVD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298036319",
            "telephone_number": "803-642-9204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHANA",
        "middle_name": "LORENE COX",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-04",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "SC",
            "license": "231529",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "25500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J & L Compounding LLC
• Becky Dixon Jackson, NURSE ANESTHETIST
• Evelena Jackson, LBSW
• Richard Jackson, DMD
• Sawyer Scott Jackson, DMD
• Sherri Denise Jackson
• Susan H. Jackson, LPC, CAC II
• William G Jackson, CRNA
• Stephanie Alyssa Catherine Jaffe, AU.D.
• James Lowell Hagan,Sr, M.D., LLC.

• Pediatric Nurse Practitioner in Aiken, SC
• Providers in Aiken, SC by specialty
• Pediatric Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.