Phillip Corey Jackson, MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E3074 Issued in AR

Legal business name

PHILLIP COREY JACKSON, MD PA

Practice address

1417 Gladden St
Harrison, AR 72601-5121

Phone

(870) 741-0016

Fax

(870) 741-4242

NPI assigned

Oct 16, 2007

Last updated

Jun 6, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Phillip Corey Jackson, M.D.NPI 1548227481

Title

Owner

Phone

(870) 741-0016

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip Corey Jackson, MD PA

  • Family Medicine Physician
  • Harrison, AR
  • NPI 1548227481
  Authorized official Same address or phone
• Kimberly Kay Regnier, PA-C

  • Medical Physician Assistant
  • Branson, MO
  • NPI 1770773715
  NPD (past)

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1821287830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726015121",
            "telephone_number": "870-741-0016",
            "fax_number": "870-741-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 GLADDEN ST",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726015121",
            "telephone_number": "870-741-0016",
            "fax_number": "870-741-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP COREY JACKSON, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "COREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-741-0016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E3074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5F478",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Petty
• Randi Jo Peyrot
• Ashleigh Elizabeth Pharis, MS, RD, LD
• Dawn Marie Phelps, M.D.
• Philip E. Milam, DDS PA
• Ashley Nicole Phillips
• Sheila Phillips
• Kelsey Evelyn Pillow
• Payton Deloss Plymale
• Stephen Philip Powers

• Family Medicine Physician in Harrison, AR
• Providers in Harrison, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; 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.