Healthcare Provider Details

I. General information

NPI: 1801710892
Provider Name (Legal Business Name): SHAUNA R JACKSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

IV. Provider business mailing address

5113 MILLER RD
SAINT JOSEPH MO
64505-1341
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-6818
  • Fax: 816-232-6823
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026012819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: