Individual
SHAKIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 COPPER BEECH DR APT C, RADFORD, VA 24141-3194
(540) 649-0780
Mailing address
100 COPPER BEECH DR APT C, RADFORD, VA 24141-3194
(540) 649-0780
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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