Individual
MRS. DANNA SHAYE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6524 U S HIGHWAY 98, HATTIESBURG, MS 39402-8569
(601) 268-9393
Mailing address
115 HOWARD HEIGHTS RD, POPLARVILLE, MS 39470-7454
(601) 447-8778
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
905263
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/25/2020
Last updated
05/19/2022
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