Samantha Rose Jackson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R71659 Issued in AR

Practice address

75 Hwy 62-412
Ash Flat, AR 72513

Phone

(870) 994-7060

Fax

(870) 994-7063

NPI assigned

Jan 14, 2009

Last updated

Dec 8, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Rose Costner Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Registered Nurse

State licenses

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.

• Families, Inc of Arkansas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ash Flat, AR
  • NPI 1174613939
  NPD (past)

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1366689267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE ROAD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72404",
            "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": "75 HWY 62-412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "72513",
            "telephone_number": "870-994-7060",
            "fax_number": "870-994-7063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SAMANTHA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-14",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R71659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "COSTNER",
            "middle_name": "ROSE",
            "credential": "RN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Patricia Horton, RECOVERY ASSISTANT
• Linda Hutchins, BA
• Sabrina Irvine, CMP
• Isaacs Occupational Therapy, LLC
• Melanie Ann Isaacs
• Tessa Johnson, RECOVERY ASSISTANT
• Kenneth Jones, RECOVERY ASSISTANT
• Keri Kalmus, RECOVERY ASSISTANT
• Tiffany Lillian Kellems, CDA
• Matthew Ryan Keller, LPC

• Registered Nurse in Ash Flat, AR
• Providers in Ash Flat, AR by specialty
• Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.