NPIMap

Organization Active NPI

J. W Nuckolls MD

  • Clinic/Center
  • Pine Bluff, AR
National Provider Identifier
1750345575
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
R2177 Issued in AR
Legal business name
J. W NUCKOLLS MD
Practice address
1801 W 40TH Ave
Suite 1C
Pine Bluff, AR 71603-6956
Phone
(870) 541-0222
Fax
(870) 541-0315
NPI assigned
Apr 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2007

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

Authorized official

Name
Dr. J. W Nuckolls, M.D.NPI 1881873826
Title
Owner
Phone
(870) 541-0222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X R2177 AR Primary

Addresses

Primary practice location

1801 W 40TH Ave
Suite 1C
Pine Bluff, AR 71603-6956

Mailing address

1801 West 40TH
Suite 1-C
Pine Bluff, AR 71603-6956
Phone (870) 541-0222

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1750345575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 WEST 40TH",
            "address_2": "SUITE 1-C",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036956",
            "telephone_number": "870-541-0222",
            "fax_number": "870-541-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE",
            "address_2": "SUITE 1C",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036956",
            "telephone_number": "870-541-0222",
            "fax_number": "870-541-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. W NUCKOLLS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "NUCKOLLS",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-541-0222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "R2177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; 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.