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NPI Code Detail

MEDICARE: DR. JASMINE SIMONE MCKISSICK MD

MEDICARE: DR. JASMINE SIMONE MCKISSICK 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
1207Q00000XFamily Medicine PhysicianE-17905AR

General Provider Information

NPI Number : 1619553393
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASMINE SIMONE MCKISSICK MD
Provider Business Mailing Address
First Line : 535 JORDAN DR
Second Line :
City : MONTICELLO
State : AR
Zip : 71655-5714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 535 JORDAN DR
Second Line :
City : MONTICELLO
State : AR
Zip : 71655-5714
Country : US
Telephone Number : 870-367-6246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2021
Last Update Date : 02/06/2026

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Directions to “ DR. JASMINE SIMONE MCKISSICK MD” Practice Location

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