Provider Demographics
NPI:1043566383
Name:JACKSON, SHARON (APRN, FNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:5247 DIDESSE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-765-7632
Practice Address - Fax:225-215-2194
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN115717 AP06897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2309544Medicaid
LARN115717 AP06897OtherLOUISIANA STATE BOARD OF NURSE EXAMINERS
LA246703YJ6VMedicare PIN