Healthcare Provider Details

I. General information

NPI: 1922762947
Provider Name (Legal Business Name): SHARIE JACKSON MSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5659 VANDERBILT DR
MOBILE AL
36608-3048
US

IV. Provider business mailing address

5659 VANDERBILT DR
MOBILE AL
36608-3048
US

V. Phone/Fax

Practice location:
  • Phone: 251-459-0518
  • Fax:
Mailing address:
  • Phone: 251-459-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-107857
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: