Provider Demographics
NPI:1225236979
Name:JACKSON, SHERYD J (RNC, MS, WHNP)
Entity Type:Individual
Prefix:MS
First Name:SHERYD
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RNC, MS, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3924
Mailing Address - Country:US
Mailing Address - Phone:210-558-2010
Mailing Address - Fax:210-696-0749
Practice Address - Street 1:3506 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3924
Practice Address - Country:US
Practice Address - Phone:210-558-2010
Practice Address - Fax:210-696-0749
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX464901363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health