MEDICARE: KIMBERLY M JACKMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ARE6415	AR
2	282N00000X	General Acute Care Hospital	390200000X	AR
3	282N00000X	General Acute Care Hospital		FL

General Provider Information

NPI Number	:	1437342052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M JACKMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 21850
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71903-1850
Country	:	US
Telephone Number	:	501-627-1800
Fax Number	:	501-627-1899

Provider Business Practice Location Address
First Line	:	ONE MERCY LANE
Second Line	:	SUITE 201
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6441
Country	:	US
Telephone Number	:	501-609-2229
Fax Number	:	501-321-4057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/12/2010

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