Individual
SHANA LORENE COX JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
206 CENTRE SOUTH BLVD, AIKEN, SC 29803-6319
(803) 642-9204
Mailing address
206 CENTRE SOUTH BLVD, AIKEN, SC 29803-6319
(803) 642-9204
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
231529
SC
363LP0200X
Pediatric Nurse Practitioner
Primary
25500
SC
Other
Enumeration date
10/04/2020
Last updated
10/29/2021
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