Doctor Name: | SHARLLETTA JACKSON |
NPI Number: | 1003223876 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 505 Highway J North Hayti, MO - 63851 |
Business Phone Number: | 5733592600 |
Business Fax Number: | |
Mailing Address: | 505 Highway J North, HAYTI |
State: | MO |
Postal Code: | 63851 |
Phone Number: | 5733592600 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2014 |
NPI Last Update Date: | 07/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |