Active NPI
Jentry Edward Tillman, LCSW
- Clinical Social Worker
- North Little Rock, AR
National Provider Identifier
1811285620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7490-C
- Practice address
- Camp Joseph T Robinson
North Little Rock, AR 72199-0001 - Phone
- (501) 212-5441
- NPI assigned
- Jul 13, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7490-C | AR | Primary |
Addresses
Primary practice location
Camp Joseph T Robinson
North Little Rock, AR 72199-0001
Mailing address
PO Box 009
North Little Rock, AR 72199-0001
Phone (501) 212-5441
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 |
|---|---|---|---|
| 7490-C | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482364800000",
"number": "1811285620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 009",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721990001",
"telephone_number": "501-212-5441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CAMP JOSEPH T ROBINSON",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721990001",
"telephone_number": "501-212-5441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "JENTRY",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-13",
"last_updated": "2016-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "7490-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.