Jack T Fendley, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C4596 Issued in AR

Practice address

3500 Springhill Dr Ste 100
North Little Rock, AR 72117-2949

Phone

(501) 955-5589

Fax

(501) 955-5960

NPI assigned

Dec 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521763200000",
    "number": "1821074592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-812-7215",
            "fax_number": "501-812-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 SPRINGHILL DR STE 100",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172949",
            "telephone_number": "501-955-5589",
            "fax_number": "501-955-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDLEY",
        "first_name": "JACK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2018-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C4596",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "C4596",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "C4596",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "AR",
            "license": "C4596",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AR",
            "license": "C4596",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "C4596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE ID",
            "identifier": "0420289",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCARE PROVIDER ID",
            "identifier": "110190362",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE PROVIDER ID",
            "identifier": "11306000000",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106701001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "4234056",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saman Farr, D.O, M.SC.
• Dorothy Farris, M.S., CCC-SLP
• Ja'Kiya Kristeria Farris
• Melinda Jo Felkins, RDH
• Traynesha Makiya Renee Fells
• Joshua Ferguson, PT. DPT. MSOP, LPO
• Agustin Fernandez, MD
• Lytonya Ferrell
• Finders Keepers Disability Service Inc
• Deandra Finley

• Internal Medicine Physician in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Internal Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.

Verify at the official NPI Registry.