Individual
SHELBY L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 397-5172
(505) 397-5172
Mailing address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 397-5172
(505) 397-5172
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
S1-1776
NM
374J00000X
Doula
0018-2025
NM
Other
Enumeration date
04/16/2025
Last updated
05/29/2025
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