Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
SHANNON JACKSON, PA-C
ActiveSHANNON JACKSON, PA-C is a Physician Assistant healthcare provider located in MISHAWAKA, Indiana. NPI 1134616584 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · MISHAWAKA, IN
Registration Details
- NPI Number
- 1134616584
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Apr 20, 2018 (8.2916318864735 yrs)
- Last Updated
- Oct 14, 2025
- Licenses
-
10005009A (IN)5601011128 (MI)
Practice Information
- Address
-
611 E DOUGLAS RD STE 203MISHAWAKA, IN, 465451467Browse IN providers · Browse ZIP 46545
- Phone
- 5743356640
- Fax
- 5743350621
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Physician Assistant
Other Physician Assistant Providers in MISHAWAKA, IN
| Name | Credential | NPI |
|---|---|---|
| SUSAN MARIE WASSENHOVE | PA-C | 1861420341 |
| JOHN L KITTREDGE | PA | 1750316196 |
| ANGELA MARIE WRIGHT | PA | 1508013418 |
| MRS. DIANA E PEREZ - SOLANO | PA-C | 1275802332 |
| MASON P HAYE | PA-C, ATC | 1871100503 |
| MRS. TANYA CHRISTINA VOGT | PA-C | 1548856073 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.