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NPI Code Detail

MEDICARE: PAMELA DENISE JACKSON

MEDICARE: PAMELA DENISE JACKSON
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1447742408
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA DENISE JACKSON
Provider Business Mailing Address
First Line : 1600 ALDERSGATE RD STE 200
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-6676
Country : US
Telephone Number : 501-661-0720
Fax Number : 501-325-7938
Provider Business Practice Location Address
First Line : 613 N FISHER ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-2152
Country : US
Telephone Number : 870-932-6922
Fax Number : 870-910-4999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2018
Last Update Date : 09/21/2021

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Directions to “ PAMELA DENISE JACKSON ” Practice Location

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