Provider Demographics
NPI:1598862690
Name:JACKSON-EVANS, CATHERINE SHEILA (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SHEILA
Last Name:JACKSON-EVANS
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4837
Mailing Address - Fax:317-865-8157
Practice Address - Street 1:8865 W 400 N
Practice Address - Street 2:SUITE 130
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9222
Practice Address - Country:US
Practice Address - Phone:219-879-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01003207V00000X
GA050188207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201160860Medicaid
GA00919652AMedicaid
GA00919652AMedicaid
IN471400108Medicare UPIN
IN201160860Medicaid