Individual
MS. SHAVOKA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20375 SECRETARIAT, GULFPORT, MS 39503-4596
(601) 566-5265
Mailing address
20375 SECRETARIAT, GULFPORT, MS 39503-4596
(601) 566-5265
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
MS
Other
Enumeration date
10/14/2019
Last updated
02/04/2020
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