Individual
SHAWN BARRETT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M,D,
Contact information
Practice address
1000 E PRIMROSE ST STE 550, SPRINGFIELD, MO 65807-5180
(417) 269-4646
Mailing address
1000 E PRIMROSE ST STE 550, SPRINGFIELD, MO 65807-5180
(417) 269-4646
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
2005005716
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2005005716
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101160
UNITED HEALTHCARE
MO
01
—
1559
BLUECROSSBLUESHIELD-PATHO
MO
01
—
159012
BLUECROSSBLUESHIELD-TRI-L
MO
01
—
421539307
FED TAX ID-TRI-LAKES PATH
MO
01
—
431451388
FED TAX ID-PATHOLOGY SERV
MO
05
—
700100407
—
MO
05
—
705866705
—
MO
Enumeration date
11/06/2006
Last updated
01/02/2026
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