Healthcare Provider Details

I. General information

NPI: 1912827387
Provider Name (Legal Business Name): QUINCI JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MEDICAL PLZ STE 2
MOUNTAIN HOME AR
72653-2919
US

IV. Provider business mailing address

4402 WHITE HORN PL
HARRISON AR
72601-8267
US

V. Phone/Fax

Practice location:
  • Phone: 870-232-5315
  • Fax:
Mailing address:
  • Phone: 870-580-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTEMP215388
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: