David C Jacks MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

C5066 Issued in AR

Legal business name

DAVID C JACKS MD PA

Practice address

4303 S Mulberry St
Pine Bluff, AR 71603-7017

Phone

(870) 535-4221

Fax

(870) 535-4228

NPI assigned

Feb 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Judy Frizielle, LPN

Title

Billing Manager/ Nurse

Phone

(870) 535-4221

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1083882633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4303 S MULBERRY ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037017",
            "telephone_number": "870-535-4221",
            "fax_number": "870-535-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 S MULBERRY ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037017",
            "telephone_number": "870-535-4221",
            "fax_number": "870-535-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID C JACKS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-18",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "FRIZIELLE",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "BILLING MANAGER/ NURSE",
        "authorized_official_telephone_number": "870-535-4221",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "C5066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104930001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Debra Venola Davis, FNP-BC
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• Specialist in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.