Healthcare Provider Details

I. General information

NPI: 1053714998
Provider Name (Legal Business Name): SHARON JAMESON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEMORIAL DR STE 210
ALTON IL
62002
US

IV. Provider business mailing address

4 MEMORIAL DR STE 210
ALTON IL
62002-6751
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-8829
  • Fax: 618-465-5499
Mailing address:
  • Phone: 618-465-8829
  • Fax: 618-465-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number192142
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041437333
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209013757
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: