Provider Demographics
NPI:1477781201
Name:JACKSON, SHERIDA L (NP)
Entity Type:Individual
Prefix:
First Name:SHERIDA
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-349-6900
Mailing Address - Fax:504-340-4305
Practice Address - Street 1:3909 LAPALCO BLVD
Practice Address - Street 2:STE 200
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2302
Practice Address - Country:US
Practice Address - Phone:504-349-6900
Practice Address - Fax:504-340-4305
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP05608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05608OtherLICENSE