NPI 1265229595

Eboni Shantelle Jackson

Practitioner Peer Specialist Cody, WY

Practice location

Address: 707 Sheridan Ave, Cody, WY 82414-3409
Phone: (307) 578-2486
Fax: (307) 578-2247

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X Licence 190 (WY)

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Registry record

NPI: 1265229595
Entity type: Individual
Sex (as registered): Female
NPI issued: 21 Apr 2025
Record last updated: 5 Mar 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.