Andrea Jackson

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

PTA2294 Issued in AR

Practice address

2120 S Waldron Rd Ste C
Fort Smith, AR 72903-3689

Phone

(479) 452-0424

NPI assigned

Nov 6, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nikki Jackson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1861215840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13364 HIGHWAY 219",
            "city": "OZARK",
            "state": "AR",
            "postal_code": "729498939",
            "telephone_number": "479-209-2545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 S WALDRON RD STE C",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033689",
            "telephone_number": "479-452-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "AR",
            "license": "PTA2294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKKI",
            "last_name": "JACKSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• J & S Fry Enterprises, Inc.
• J Brogan Lopez DDS PA
• J Michael Standefer MD PA
• J Steven Yaney
• J.B. Solomon, Inc.
• Audra M Jackson, MD
• Carolyn Jackson
• Janissa D Jackson, PHD
• Jennifer Jackson, RDS, CIT
• McKenzie Alexandra Jackson, MD

• Rehabilitation Practitioner in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Rehabilitation Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.