Provider Demographics
NPI:1922762947
Name:JACKSON, SHARIE (MSN,RN)
Entity Type:Individual
Prefix:MRS
First Name:SHARIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3048
Mailing Address - Country:US
Mailing Address - Phone:251-459-0518
Mailing Address - Fax:
Practice Address - Street 1:5659 VANDERBILT DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3048
Practice Address - Country:US
Practice Address - Phone:251-459-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107857163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-107857OtherALABAMA BOARD OF NURSING