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EBONI SHANTELLE JACKSON
NPI 1265229595
Peer Specialist in Cody, WY

Active since April 21, 2025
707 SHERIDAN AVE, CODY, WY 82414(307) 578-2486(307) 578-2247 Get Directions Write a Review

NPPES record last updated: March 5, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Eboni Shantelle Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBONI SHANTELLE JACKSON (NPI 1265229595) is an individual peer specialist in Cody, Wyoming, licensed in Wyoming (190) and active in the NPI registry since April 2025. She maintains 2 additional practice locations.

NPPES Registry Identity

NPI1265229595
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameEBONI SHANTELLE JACKSON
Location Address707 SHERIDAN AVECody, WY 82414-3409
Mailing Address707 Sheridan AveCody, WY 82414-3409 · (307) 578-2486 · Fax (307) 578-2247
Phone(307) 578-2486
Fax(307) 578-2247
Sole ProprietorNo
Enumeration DateApril 21, 2025
Last NPPES UpdateMarch 5, 2026
NPPES CertifiedMarch 5, 2026
✔ NPI 1265229595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in WY · 190
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
707 SHERIDAN AVE, Cody, WY 82414
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Secondary Practice Locations 2

Location 1507 N Clark StPowell, WY 82435-1915 · Phone (307) 754-7970 · Fax (307) 333-0470
Location 2125 S Division StPowell, WY 82435-2409 · Phone (307) 754-7970 · Fax (307) 333-0470

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GREGORY H CROSS II MD
Radiology (Diagnostic Radiology)
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 578-2582
MONIQUE HELENA KEENAN PT, MPT
Physical Therapist
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 578-2452
FRED A SNELSON
Counselor (Addiction (Substance Use Disorder))
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 527-7501
LORI TYSON RNFA
Registered Nurse (Registered Nurse First Assistant)
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 578-6293
WEST PARK HOSPITAL HOME HEALTH
Hospice Care, Community Based
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 527-7501
STEPHANIE I KNODEL
Emergency Medicine
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 578-2000
MS. SHELLY MARIE GREEN CRNA
Nurse Anesthetist, Certified Registered
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 587-2139
KATHRYN LEE CARTER NP
Nurse Practitioner (Pediatrics, Critical Care)
707 SHERIDAN AVE
CODY, WY 82414
Park County (307) 527-7501

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eboni Jackson's NPI number?

The NPI number for Eboni Jackson is 1265229595. It was assigned to this individual provider in the NPPES registry on April 21, 2025.

Where is Eboni Jackson located?

Eboni Jackson practices at 707 Sheridan Ave, Cody, WY 82414. The listed phone number is (307) 578-2486.

What is Eboni Jackson's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Eboni Jackson was last updated on March 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.