| NPI | 1811323645 |
|---|---|
| Professional Name | SHANNON DENISE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP07433) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 801526) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2022-12-13 |