Sharon Rena Jackson

Primary specialty

Health EducatorTaxonomy code 174H00000X

License

11452 Issued in NC

Practice address

2847 Jack Rd
Clayton, NC 27520-8421

Phone

(919) 434-5689

Fax

(919) 679-4049

NPI assigned

Jun 16, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1891311734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14305",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276204305",
            "telephone_number": "919-434-5689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2847 JACK RD",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275208421",
            "telephone_number": "919-434-5689",
            "fax_number": "919-679-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHARON",
        "middle_name": "RENA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NC",
            "license": "11452",
            "primary": true
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "NC",
            "license": "269855",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monette Irwin, L.C.S.W.
• Alexis Jackson, MA, BCBA, LBA
• Carmesia Jackson
• Deja De'Shea Jackson, LCSWA
• Erica Boswell Jackson
• Jacob's Ladder Childhood Therapy
• Jacqueline Wardrett
• Jak Counseling Services
• Andre Jakewell
• Jannie's Ride Inc

• Health Educator in Clayton, NC
• Providers in Clayton, NC by specialty
• Health Educator in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.