Jackson, Shanda
Jackson, Shanda is an sole proprietor health care provider with primary practice located at 6569 Highway 84 , Ferriday LA 71334-4573. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Shanda can be contacted via phone (985) 892-7070.Contact Information
Primary practice address
6569 Highway 84
Ferriday LA 71334-4573
Phone: (985) 892-7070
Fax: (855) 821-4499
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | AP06672 | Louisiana |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | R855819 | Mississippi |
Profile Details
| NPI number | 1578846598 |
|---|---|
| LBN Legal business name | Jackson, Shanda |
| Credentials | FNP-C |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 26th, 2011 |
| Last updated | Jun 30th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578846598 | NPPES |
| Mississippi | MEDICAID | 09503346 | |
| Mississippi | MEDICAID | 2319248 | |
| Mississippi | Other | F0711469 |
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