Healthcare Provider Details

I. General information

NPI: 1861310534
Provider Name (Legal Business Name): JILLIAN BACCHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E HARDING ST
MORRILTON AR
72110-1540
US

IV. Provider business mailing address

365 COUNTY ROAD 1699
KNOXVILLE AR
72845-8563
US

V. Phone/Fax

Practice location:
  • Phone: 870-351-8201
  • Fax:
Mailing address:
  • Phone: 870-351-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: