Healthcare Provider Details

I. General information

NPI: 1679992788
Provider Name (Legal Business Name): JENNIFER COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S WALDRON RD STE B
FORT SMITH AR
72903-3700
US

IV. Provider business mailing address

2200 S WALDRON RD STE B
FORT SMITH AR
72903-3700
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-7111
  • Fax: 479-242-2033
Mailing address:
  • Phone: 479-242-7111
  • Fax: 479-242-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: