Derrick Jackson, MHPP

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

177 Bush Street
Building 77
Hughes, AR 72348

Phone

(870) 339-3701

Fax

(870) 339-3941

NPI assigned

Sep 13, 2013

Last updated

Sep 13, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Strategies of Arkansas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hughes, AR
  • NPI 1699911537
  NPD (past)

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379030400000",
    "number": "1225463847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 CALVIN AVERY DR",
            "address_2": "SUITE A",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723016501",
            "telephone_number": "870-732-1878",
            "fax_number": "870-702-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 BUSH STREET",
            "address_2": "BUILDING 77",
            "city": "HUGHES",
            "state": "AR",
            "postal_code": "72348",
            "telephone_number": "870-339-3701",
            "fax_number": "870-339-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DERRICK",
        "name_prefix": "Mr.",
        "credential": "MHPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jefferson Arnold Dunaway, RPH
• Dunaway's Family Pharmacy Inc.
• Hughes Medical Equipment
• Hughes Medical Equipment Inc
• Hughes School District
• Charles Jones Jr., M.D.
• Lee County Cooperative Clinic (Hughes Satellite Clinic)
• Life Strategies of Arkansas
• Erica Montgomery, MHPP
• New Visions of Arkansas

• Case Manager/Care Coordinator in Hughes, AR
• Providers in Hughes, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.