Shannon Jackson
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Meridian, MS
NPI 1821834474 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1821834474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 4107 58TH PL
Meridian, MS 39307-2925 - Phone
- (601) 917-9830
- NPI assigned
- Jul 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
4107 58TH PL
Meridian, MS 39307-2925
Mailing address
4107 58TH PL
Meridian, MS 39307-2925
Phone (601) 917-9830
Other providers in Meridian, MS
- J. Britt McCarty DMD PA
- Jackson Vamc
- Amanda Raye Jackson
- Paige Jackson
- Quiyona Jackson
- Jacqueline L Pierre OD Faao LLC
- Mohamed Bockarie Jah
- James R. Watson, MD, Orthopedic & Sports Medicine, PLLC
- James W. Hover, DDS, PA
- Rebecca James
All providers in Meridian, MS · Student in an Organized Health Care Education/Training Program in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.