Healthcare Provider Details

I. General information

NPI: 1336004985
Provider Name (Legal Business Name): JACI AMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W HIGHWAY 89
CABOT AR
72023-7944
US

IV. Provider business mailing address

601 W HIGHWAY 89
CABOT AR
72023-7944
US

V. Phone/Fax

Practice location:
  • Phone: 903-277-6531
  • Fax:
Mailing address:
  • Phone: 903-277-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5792
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: