Active NPI
Kimberly R Jackson
- Developmental Therapist
- Warren, AR
National Provider Identifier
1043597867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 206 Bragg St
Warren, AR 71671-2500 - Phone
- (870) 226-7844
- Fax
- (870) 226-2798
- NPI assigned
- Nov 8, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
206 Bragg St
Warren, AR 71671-2500
Mailing address
1 Childrens Way
Slot 512-39
Little Rock, AR 72202-3500
Phone (501) 364-3620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Arkansas for Medical Sciences | Past | Accepting new patients | |
| University of Arkansas for Medical Sciences | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Little Rock, AR
- NPI 1346230968
-
- Developmental - Behavioral Pediatrics Physician
- Warren, AR
- NPI 1477628352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320710400000",
"number": "1043597867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHILDRENS WAY",
"address_2": "SLOT 512-39",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722023500",
"telephone_number": "501-364-3620",
"fax_number": "501-364-5192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 BRAGG ST",
"city": "WARREN",
"state": "AR",
"postal_code": "716712500",
"telephone_number": "870-226-7844",
"fax_number": "870-226-2798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIMBERLY",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-08",
"last_updated": "2011-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.