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General NPI Number Information
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NPI Number | 1134575947
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Entity Type | Individual
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Provider Name | SHAUNTE V JACKSON MSN,APRN,FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 1918 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-6232
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Country | US
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Telephone | 504-471-4860
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Fax | 504-930-4218
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Provider Business Mailing Address
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Address Line | 1918 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-6232
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Country | US
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Telephone | 504-471-4860
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Fax | 504-930-4218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 225486
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License Number State | LA
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