Provider Demographics
NPI:1184605925
Name:JACKSON, SHARRON MCKINNEY (RN)
Entity type:Individual
Prefix:MRS
First Name:SHARRON
Middle Name:MCKINNEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 MEANDERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-4388
Mailing Address - Country:US
Mailing Address - Phone:703-361-7346
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD, STE GC11
Practice Address - Street 2:DEWITT ARMY HOSPITAL
Practice Address - City:FT BELVIOR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001096964163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator