Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1265229595 Individual Practitioner Female Practitioner

Eboni Shantelle Jackson

Peer Specialist • Cody, WY

Professional Overview & Biography Verified Profile Summary

Eboni Jackson is a registered healthcare professional specializing in Peer Specialist in Cody, WY. Practice services are available at 707 SHERIDAN AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

707 Sheridan Ave

Cody, WY 824143409

Telephone 3075782486
Fax 3075782247
Associated Practice Facility / Clinic
🏢 Yellowstone Radiology Pc Facility NPI 1376536763

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Cody, WY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
2 Specialists

Practicing in Cody, WY (89 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-03-05
Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License WY 190

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Secondary Practice Locations

507 N Clark St

Powell, WY 824351915

Phone: 3077547970

125 S Division St

Powell, WY 824352409

Phone: 3077547970

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
NPI 1649507658

Doctor of Philosophy (Ph.D.), National Certified Counselor, Licensed Athletic Trainer, Licensed Professional Counselor

Cassidy Steward , FNP

Nurse Practitioner - Family

NPI 1669207536

Family Nurse Practitioner

Dr. Elizabeth Gauer , MD

Internal Medicine - Interventional Cardiology

NPI 1912953498

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location March 05, 2026

Registered at 707 SHERIDAN AVE, CODY, WY 824143409 (Tel: 3075782486)

📍
Updated Business Mailing Address March 05, 2026

Registered at 707 SHERIDAN AVE, CODY, WY 824143409 (Tel: 3075782486)

NPI Profile Active April 21, 2025

NPI status registered as active in NPPES database

📍
Updated Practice Location April 21, 2025

Registered at 125 S DIVISION ST, POWELL, WY 824352409 (Tel: 3077547970)

📍
Updated Business Mailing Address April 21, 2025

Registered at PO BOX 847, POWELL, WY 824350847 (Tel: 3077547970)

👤
Provider Name / Credentials Updated April 21, 2025

Recorded as EBONI JACKSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 21, 2025

Peer Specialist (License #190 in WY)

🟢
Initial NPI Registration & Enumeration April 21, 2025

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1265229595
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 21, 2025
Last Update: March 05, 2026
Sole Proprietor: No

Mailing Address

707 Sheridan Ave

Cody, WY 824143409

Phone: 3075782486

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.