Chanelle C Jackson (NPI# 1629510862, PAC ID# 5496031569) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1629510862 |
| PAC ID by PECOS | 5496031569 |
| Professional Enrollment ID | I20170405000041 |
| Full Name | Chanelle C Jackson |
| Organization Legal Name | WAL-MART STORES EAST LP |
| Address |
2240 W Dekalb St Camden SC 29020-2069 |
| Phone Number | 8039006028 |
| Gender | F |
| Graduation Year | 2016 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 6204749997 |
| Number of Group Practice Members | 21 |
| Accepts Medicare Assignment | M |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 420048 | KERSHAWHEALTH |
| Address | Phone | Organization |
|---|---|---|
| 2240 W Dekalb St, Camden, SC 29020-2069 | 8039006028 | WAL-MART STORES EAST LP |
| Organization Legal Name | WAL-MART STORES EAST LP |
| Physicians | 30 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anne O'brien | Nurse Practitioner | Wal-mart Stores East Lp | 5448 Whittlesey Blvd B, Columbus, GA 31909-7298 |
| Mary Jane Mcmanus | Nurse Practitioner | Wal-mart Stores East Lp | 1283 Broad St, Sumter, SC 29150-1973 |
| Sheryl Hyman | Nurse Practitioner | Wal-mart Stores East Lp | 230 N Beltline Dr, Florence, SC 29501-7403 |
| Sandra D Randolph | Nurse Practitioner | Wal-mart Stores East Lp | 2240 W Dekalb St, Camden, SC 29020-2069 |
| Jennifer Dania Woods | Nurse Practitioner | Wal-mart Stores East Lp | 5448 Whittlesay Blvd B, Columbus, GA 31909-7298 |
| Mary R Dortenzo | Nurse Practitioner | Wal-mart Stores East Lp | 1201 Knox Ave, North Augusta, SC 29841-4056 |
| Muna E Wagner | Nurse Practitioner | Wal-mart Stores East Lp | 1735s Hwy 27, Carrollton, GA 30117-8941 |
| Dorwoah Tomah Counts | Nurse Practitioner | Wal-mart Stores East Lp | 10060 Two Notch Rd, Columbia, SC 29223-4396 |
| Robin L Roe | Nurse Practitioner | Wal-mart Stores East Lp | 518 Shugart Rd, Dalton, GA 30720-2444 |
| Beverly B Beltran | Nurse Practitioner | Wal-mart Stores East Lp | 2510 Redmond Nwcir, Rome, GA 30165-1913 |
| Street Address |
2240 W DEKALB ST |
| City | CAMDEN |
| State | SC |
| Zip | 29020-2069 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sandra D Randolph | Nurse Practitioner | Wal-mart Stores East Lp | 2240 W Dekalb St, Camden, SC 29020-2069 |
| Janette M Capaci | Nurse Practitioner | Wal-mart Stores East Lp | 2240 W Dekalb St, Camden, SC 29020-2069 |
| Sandra A Jones | Nurse Practitioner | Wal-mart Stores East Lp | 2240 W Dekalb St, Camden, SC 29020-2069 |
| Patricia A Siefferman | Nurse Practitioner | Wal-mart Stores East Lp | 2240 W Dekalb St, Camden, SC 29020-2069 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brittany Nicole Jones | Nurse Practitioner | Lowcountry Urgent Care LLC | 2010 W Dekalb St, Camden, SC 29020-2058 |
| Jonathan Braun Ksor | Podiatry | Carolina Podiatry Clinic LLC | 2502 Broad St, Camden, SC 29020-2225 |
| John Ksor | Podiatry | Carolina Podiatry Clinic LLC | 2502 Broad St, Camden, SC 29020-2225 |
| James Huger Richardson | Cardiovascular Disease (cardiology) | Providence Group Practices II LLC | 1330 Haile St, Camden, SC 29020-3002 |
| Venkateshwar K Gottipaty | Cardiac Electrophysiology | Providence Group Practices II LLC | 1330 Haile St, Camden, SC 29020-3002 |
| Shelly C Wilkerson | Nurse Practitioner | Providence Group Practices LLC | 1330 Haile St, Camden, SC 29020-3002 |
| Anne Marie Hendrix | Physician Assistant | Providence Group Practices LLC | 1330 Haile St, Camden, SC 29020-3002 |
| James C Kearse Iii | Family Medicine | Sentinel Health Partners Pa | 1344 Haile St, Camden, SC 29020-3076 |
| Ashley B Divers | Nurse Practitioner | Sentinel Health Partners Pa | 1344 Haile St, Camden, SC 29020-3076 |
| Tallulah F Holmstrom | Internal Medicine | Sentinel Health Partners Pa | 1344 Haile St, Camden, SC 29020-3076 |
| Find all physicians in zip 29020 | |||
| City | CAMDEN |
| Zip Code | 29020 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | CAMDEN + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Chanelle C Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.