Active NPI
Jaclyn J Cooper, APN
- Family Nurse Practitioner
- Conway, AR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- A03480
- Practice address
- 2425 Dave Ward Dr
Suite 601
Conway, AR 72034-8686 - Phone
- (501) 773-6993
- NPI assigned
- Feb 3, 2011
- Last updated
- Apr 5, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | A03480 | AR | Primary |
Addresses
Primary practice location
2425 Dave Ward Dr
Suite 601
Conway, AR 72034-8686
Mailing address
108 N Shackleford Rd
Little Rock, AR 72211-2840
Phone (501) 712-2571
Other practice location 1
108 N Shackleford Rd
Little Rock, AR 72211-2840
Phone (501) 712-2571
Other names 1
- Jaclyn J Fikes
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
108 N Shackeford Rd
Little Rock, AR 72211-2840
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A03480 | AR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pain Treatment Centers of America, PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Little Rock, AR
- NPI 1841619731
-
dba Family Care Centers of America
- Family Medicine Physician
- Rolling Fork, MS
- NPI 1740946573
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Conway Regional Medical Clinic-Vilonia
- Rural Health Clinic/Center
- Vilonia, AR
- NPI 1063798858
Hospital
-
- General Acute Care Hospital
- Conway, AR
- NPI 1497770424
-
dba Conway Regional Medical Clinic-Russellville
- Family Medicine Physician
- Russellville, AR
- NPI 1245729359
Hospital
-
dba Conway Regional Counseling Center
- Psychiatry Physician
- Conway, AR
- NPI 1730402249
Hospital
-
dba Mayflower Medical Clinic
- Rural Health Clinic/Center
- Mayflower, AR
- NPI 1851389605
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649116800000",
"number": "1851697197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 N SHACKLEFORD RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722112840",
"telephone_number": "501-712-2571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2425 DAVE WARD DR",
"address_2": "SUITE 601",
"city": "CONWAY",
"state": "AR",
"postal_code": "720348686",
"telephone_number": "501-773-6993"
}
],
"practiceLocations": [
{
"address_1": "108 N Shackleford Rd",
"address_purpose": "LOCATION",
"city": "Little Rock",
"state": "AR",
"postal_code": "722112840",
"country_code": "US",
"telephone_number": "501-712-2571",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COOPER",
"first_name": "JACLYN",
"middle_name": "J",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-03",
"last_updated": "2022-04-05",
"certification_date": "2022-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AR",
"license": "A03480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACLYN",
"last_name": "FIKES",
"middle_name": "J",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.