Active NPI
Nedra Clem Jackson, M.D.
- Family Medicine Physician
- West Memphis, AR
National Provider Identifier
1659477164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- E-11062
- Practice address
- 900 N 7TH St
West Memphis, AR 72301-2001 - Phone
- (870) 735-3842
- Fax
- (870) 394-4872
- NPI assigned
- Sep 15, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 21180 | MS | |
| Family Medicine Physician | 207Q00000X | E-11062 | AR | Primary |
Addresses
Primary practice location
900 N 7TH St
West Memphis, AR 72301-2001
Mailing address
900 N 7TH St
West Memphis, AR 72301-2001
Phone (870) 735-3842
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302I112036 | Other | CMS CAHABA | |
| 07989840 | Medicaid | MS |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Family Medical Center | Family Medicine | Past | Accepting new patients |
| Darryl Champion | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 2
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.
-
- Radiologic Technologist
- Lebanon, TN
- NPI 1588970990
-
- Family Medicine Physician
- Baton Rouge, LA
- NPI 1598896961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515024000000",
"number": "1659477164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 N 7TH ST",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "723012001",
"telephone_number": "870-735-3842",
"fax_number": "870-394-4872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N 7TH ST",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "723012001",
"telephone_number": "870-735-3842",
"fax_number": "870-394-4872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NEDRA",
"middle_name": "CLEM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2018-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "21180",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AR",
"license": "E-11062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMS CAHABA",
"identifier": "302I112036",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07989840",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Memphis, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.