Debra A Jackson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

L030099 Issued in AR

Practice address

3450 W 34TH Ave
Pine Bluff, AR 71603-5508

Phone

(870) 534-6067

Fax

(870) 534-7297

NPI assigned

Apr 12, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1710320320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY",
            "address_2": "SLOT 512-39",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-526-8700",
            "fax_number": "501-526-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 W 34TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716035508",
            "telephone_number": "870-534-6067",
            "fax_number": "870-534-7297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEBRA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "L030099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Jacks, M.D.
• Dennis W Jacks, M.D.
• Jennifer Lynn Jacks, M.D.
• Angela Jackson, COTA
• Corey Lamont Jackson Sr., D.C.
• Denishia Nicole Jackson
• Henry Jackson
• James Jackson, PHARMD
• Janiya Jackson
• Javits L Jackson

• Licensed Practical Nurse in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Licensed Practical Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.