Ms Shavonne Jackson, NP | |
4575 Whitehill Blvd Ste 101, Prince George, VA 23875-1273 | |
(804) 643-3061 | |
(804) 643-3817 |
Full Name | Ms Shavonne Jackson |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 4575 Whitehill Blvd Ste 101, Prince George, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356052971 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 0024185612 (Virginia) | Primary |
Entity Name | Mid-atlantic Kidney Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1700855228 PECOS PAC ID: 7113821513 Enrollment ID: O20031126000043 |
Mailing Address | Practice Location Address |
---|---|
Ms Shavonne Jackson, NP 2201 E Main St Ste 201, Richmond, VA 23223-7071 Ph: (804) 643-3061 | Ms Shavonne Jackson, NP 4575 Whitehill Blvd Ste 101, Prince George, VA 23875-1273 Ph: (804) 643-3061 |
Jessica M Larche, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4600 Puddledock Rd, Prince George, VA 23875 Phone: 804-704-8655 | |
Kimberly Fox, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4140 Crossings Ct Ste 101-103, Prince George, VA 23875 Phone: 757-695-9406 | |
Tanesha Ford, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4700 Puddledock Rd Ste 300, Prince George, VA 23875 Phone: 804-526-1111 | |
Kim Parrish Dobson, FNP-C APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 5842 Allin Road, Suite A, Prince George, VA 23875 Phone: 804-895-6131 Fax: 804-895-6183 | |
Takara Joy Figueroa, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4700 Puddledock Rd, Prince George, VA 23875 Phone: 804-526-1111 | |
Mrs. Theresa Mccormack, PNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2035 Waterside Rd, Suite 105, Prince George, VA 23875 Phone: 804-520-0002 Fax: 804-520-2259 |