MS. SHAVONNE JACKSON NP
NPI 1356052971
Nurse Practitioner - Family in Colonial Heights, VA

Q: What is Shavonne Jackson's NPI number?

The NPI number for Shavonne Jackson is 1356052971. It was assigned to this individual provider in the NPPES registry on December 6, 2022.

Q: What is Shavonne Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Shavonne Jackson was last updated on July 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 06, 2022PECOS EnrolledAccepts Medicare Assignment

524 SOUTHPARK BLVD, COLONIAL HEIGHTS, VA 23834(804) 504-7980(804) 554-5387 Get Directions Write a Review

NPPES record last updated: July 10, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 10, 2024, Dec 6, 2022 (2 updates tracked since 2022).

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About Ms. Shavonne Jackson Np NPPES

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

MS. SHAVONNE JACKSON NP (NPI 1356052971) is an individual family provider in Colonial Heights, Virginia, licensed in Virginia (0024185612) and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1356052971

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMS. SHAVONNE JACKSONCredential: NP

Location Address524 SOUTHPARK BLVDColonial Heights, VA 23834-3609

Mailing Address524 Southpark BlvdColonial Heights, VA 23834-3609 · (804) 504-7980 · Fax (804) 554-5387

Phone(804) 504-7980

Fax(804) 554-5387

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 6, 2022

Last NPPES UpdateJuly 10, 20242 updates tracked since enumeration

NPPES CertifiedJuly 10, 2024

✔ NPI 1356052971 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in VA · 0024185612

524 SOUTHPARK BLVD, Colonial Heights, VA 23834

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Shavonne Jackson Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID840695201

PECOS Enrollment IDI20230329002291

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23834 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.88 typical visit price

range $56.19 – $170.30

Typical copayment $21.72 (range $14.04 – $42.57)

Most-billed visit code 99203

Established Patient

$99.13 typical visit price

range $18.07 – $138.91

Typical copayment $24.78 (range $4.51 – $34.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

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

LAURA WONG

Acupuncturist

524 SOUTHPARK BLVD, JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
COLONIAL HEIGHTS, VA 23834

Colonial Heights City (804) 504-7980

DR. REMAN DHALIWAL DPM

Podiatrist