Individual
SHELBY H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7000
Mailing address
504 CLINTON CENTER DRIVE, CBO-SUITE 4300, JACKSON, MS 39056
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903610
MS
Other
Enumeration date
02/05/2020
Last updated
03/05/2021
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