Jackie Coombe-Moore PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

JACKIE COOMBE-MOORE PA

Doing business as

Conway Psychiatric Center

Practice address

680 Hogan LN
Conway, AR 72034-8131

Phone

(501) 505-8900

Fax

(501) 505-8902

NPI assigned

Mar 12, 2010

Organization subpart

No

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

Authorized official

Name

Jackie Coombe-Moore, M.D.

Title

President

Phone

(501) 505-8900

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Conway Psychiatric Center Doing business as

Locations

Practitioners 3

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

• Jo Ann Clay, MSN, CNS, APN

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Conway, AR
  • NPI 1003843277
  NPD (past)
• Lynne Elizabeth Clifton, L.C.S.W.

  • Clinical Social Worker
  • Little Rock, AR
  • NPI 1285792523
  NPD (past)
• Sharon L D Dunaway, MSW

  • Clinical Social Worker
  • Conway, AR
  • NPI 1093810947
  NPD (past)

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269561600000",
    "number": "1841513223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 HOGAN LN",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348131",
            "telephone_number": "501-505-8900",
            "fax_number": "501-505-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 HOGAN LN",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348131",
            "telephone_number": "501-505-8900",
            "fax_number": "501-505-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKIE COOMBE-MOORE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-12",
        "last_updated": "2010-03-26",
        "status": "A",
        "authorized_official_last_name": "COOMBE-MOORE",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-505-8900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QCA",
            "identifier": "11547000000",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "55779",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122013001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Psychiatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daria Isom, CASE MANAGER PARAPRO
• Sara Fairbanks Israel, OTR/L
• J Henry Counseling, PLLC
• J J J Smith Inc
• J J J Smith, Inc
• Antwanette Jackson
• Ashley Hoelzeman Jackson, PHARM D.
• Brandon Jackson
• Brian Jackson, APRN
• Carole Lynn Jackson, MD

• Psychiatry Physician in Conway, AR
• Providers in Conway, AR by specialty
• Psychiatry Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; 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.