Active NPI
Tracy Jackson, RN
- Registered Nurse
- Osceola, AR
National Provider Identifier
1295902971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R44657
- Practice address
- 1487 W Keiser Ave
Osceola, AR 72370-2806 - Phone
- (870) 622-0592
- Fax
- (870) 622-0782
- NPI assigned
- May 13, 2008
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R44657 | AR | Primary |
Addresses
Primary practice location
1487 W Keiser Ave
Osceola, AR 72370-2806
Mailing address
4508 Stadium Blvd
Jonesboro, AR 72404-9675
Phone (870) 933-6886
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R44657 | AR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1295902971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4508 STADIUM BLVD",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724049675",
"telephone_number": "870-933-6886",
"fax_number": "870-933-9395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1487 W KEISER AVE",
"city": "OSCEOLA",
"state": "AR",
"postal_code": "723702806",
"telephone_number": "870-622-0592",
"fax_number": "870-622-0782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TRACY",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-13",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "AR",
"license": "R44657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Osceola, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.