MS. SHAVONNE JACKSON NP NPI 1356052971

NPI Information

NPI: 1356052971
Provider Name: MS. SHAVONNE JACKSON, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
4575 WHITEHILL BLVD STE 101
PRINCE GEORGE, VA
ZIP 23875
Phone: (804) 643-3061
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MS. Shavonne Jackson, NP is a family nurse practitioner in Prince George, VA. MS. Shavonne Jackson, NP NPI is 1356052971. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4575 WHITEHILL BLVD STE 101
PRINCE GEORGE, VA
ZIP 23875-273
Phone: (804) 643-3061
Fax: (804) 643-3817

The NPI 1356052971 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/6/2022 and was last updated on 12/6/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	0024185612	VIRGINIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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