MEDICARE: MRS. SHARRON MCKINNEY JACKSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	0001096964	VA

General Provider Information

NPI Number	:	1184605925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARRON MCKINNEY JACKSON RN

Provider Business Mailing Address
First Line	:	10901 MEANDERVIEW CT
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20111-4388
Country	:	US
Telephone Number	:	703-361-7346
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 FARRELL RD, STE GC11
Second Line	:	DEWITT ARMY HOSPITAL
City	:	FT BELVIOR
State	:	VA
Zip	:	22060
Country	:	US
Telephone Number	:	703-805-9329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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