Provider Demographics
NPI:1689610396
Name:SHEDDEN, JAMIE WEAVER (MSN, ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:WEAVER
Last Name:SHEDDEN
Suffix:
Gender:F
Credentials:MSN, ACNP
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:WEAVER
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ACNP
Mailing Address - Street 1:616 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2821
Mailing Address - Country:US
Mailing Address - Phone:228-865-1466
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5471
Practice Address - Fax:228-523-4971
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856481363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care