Provider Demographics
NPI:1932955903
Name:JACKSON, SHERRON DENICE (RN)
Entity type:Individual
Prefix:
First Name:SHERRON
Middle Name:DENICE
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 1:386 LEE ROAD 4
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-8644
Mailing Address - Country:US
Mailing Address - Phone:334-740-7725
Mailing Address - Fax:
Practice Address - Street 1:386 LEE ROAD 4
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-8644
Practice Address - Country:US
Practice Address - Phone:334-740-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
AL1-118681163WH0200X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult