Provider Demographics
NPI:1285468926
Name:JACKSON, RAKERA SHUNAY
Entity type:Individual
Prefix:
First Name:RAKERA
Middle Name:SHUNAY
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 MEADOW VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-8057
Mailing Address - Country:US
Mailing Address - Phone:804-536-0035
Mailing Address - Fax:
Practice Address - Street 1:2846 MEADOW VIEW BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-8057
Practice Address - Country:US
Practice Address - Phone:804-661-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health