Shannon Jackson, PA-C

NPI #1134616584 in Mishawaka, Indiana

Provider Information

NPI Number: 1134616584
Entity Type: Individual
Name: Shannon Jackson, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Apr 20, 2018
Last Updated: Oct 14, 2025

Practice Location

Address: 611 E DOUGLAS RD STE 203
City: Mishawaka
State: Indiana
ZIP Code: 46545-1467
Phone: (574) 335-6640

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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