Kim Jaquish, RNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

P01373 Issued in AR

Practice address

1500 Dodson Ave
Ste 125
Fort Smith, AR 72901-5182

Phone

(479) 573-7960

Fax

(479) 573-7961

NPI assigned

Oct 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Fort Smith Hma, LLC

  dba Sparks Regional Medical Center

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1578555736
  NPD (past)
• Sparks Medical Foundation

  dba Alma Family Medical Clinic

  • Durable Medical Equipment & Medical Supplies
  • Alma, AR
  • NPI 1861596553
  NPD (past)
• Sparks Regional Medical Center

  • Skilled Nursing Facility
  • Fort Smith, AR
  • NPI 1992916308
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1245228485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 402319",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303842319",
            "telephone_number": "479-709-7399",
            "fax_number": "479-709-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 DODSON AVE",
            "address_2": "STE 125",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729015182",
            "telephone_number": "479-573-7960",
            "fax_number": "479-573-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUISH",
        "first_name": "KIM",
        "credential": "RNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-12",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "P01373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155652741",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100013980A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noah Phillip James, DO
• Shane Jamison, DNP
• Ashley Marie Janas
• Elizabeth Janes
• Andrea Nicole Jansen, ACNP
• Jarnagin Property & Investments
• Kyle D Jarnagin, D.C.
• Adam Jarrard, PHARMD
• Holly Katherine Jarvis, LAC
• Jennifer Leann Jay, APRN, FNP-BC

• Gerontology Nurse Practitioner in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Gerontology Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.