Active NPI
Carolyn Jackson
- Physical Therapy Assistant
- Fort Smith, AR
National Provider Identifier
1740012129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA2019
- Practice address
- 9220 Highway 71 S Ste 10
Fort Smith, AR 72916-9151 - Phone
- (479) 763-1412
- Fax
- (479) 763-1425
- NPI assigned
- Aug 15, 2024
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA2019 | AR | Primary |
Addresses
Primary practice location
9220 Highway 71 S Ste 10
Fort Smith, AR 72916-9151
Mailing address
9220 Highway 71 S Ste 10
Fort Smith, AR 72916-9151
Phone (479) 763-7008
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA2019 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1740012129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9220 HIGHWAY 71 S STE 10",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729169151",
"telephone_number": "479-763-7008",
"fax_number": "479-763-1425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9220 HIGHWAY 71 S STE 10",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729169151",
"telephone_number": "479-763-1412",
"fax_number": "479-763-1425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CAROLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-15",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA2019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.