Individual
MRS. SHANDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
6569 HIGHWAY 84, FERRIDAY, LA 71334-4573
(985) 892-7070
(855) 821-4499
Mailing address
PO BOX 1089, HAMMOND, LA 70404-1089
(985) 892-7070
(985) 892-7017
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP06672
LA
363LF0000X
Family Nurse Practitioner
Primary
R855819
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09503346
—
MS
05
—
2319248
—
LA
01
—
F0711469
CERTIFICATION NUMBER
MS
Enumeration date
09/26/2011
Last updated
06/30/2022
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