Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
EBONI SHANTELLE JACKSON
ActiveEBONI SHANTELLE JACKSON is a Peer Specialist healthcare provider located in CODY, Wyoming. NPI 1265229595 is currently active in the NPPES registry. Verify at CMS.
Peer Specialist · CODY, WY
Registration Details
- NPI Number
- 1265229595
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Apr 21, 2025 (1.2706299959879 yrs)
- Last Updated
- Mar 5, 2026
- License
-
190 (WY)
Practice Information
- Address
-
707 SHERIDAN AVECODY, WY, 824143409Browse WY providers · Browse ZIP 82414
- Phone
- 3075782486
- Fax
- 3075782247
- Primary Specialty
-
Peer Specialist
175T00000X
Other Peer Specialist Providers in CODY, WY
| Name | Credential | NPI |
|---|---|---|
| JAQUELINE FALES | PEER SUPPORT SPECIAL | 1962179903 |
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.