Individual
SHARONDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
192 KACEY LN, WAVELAND, MS 39576-2540
(228) 343-1945
Mailing address
192 KACEY LN, WAVELAND, MS 39576-2540
(228) 343-1945
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
907616
MS
Other
Enumeration date
07/28/2025
Last updated
07/28/2025
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