Healthcare Provider Details

I. General information

NPI: 1679486427
Provider Name (Legal Business Name): BRIANNA MICHELE JACKSON HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BRUNK ST
PRAIRIE GROVE AR
72753-3245
US

IV. Provider business mailing address

215 BRUNK ST
PRAIRIE GROVE AR
72753-3245
US

V. Phone/Fax

Practice location:
  • Phone: 918-208-8914
  • Fax:
Mailing address:
  • Phone: 918-208-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: