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General NPI Number Information
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NPI Number | 1053372946
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Entity Type | Individual
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Provider Name | MARTHA A JACKSON DPM
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 2501 CRESTWOOD RD SUITE 101
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7615
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Country | US
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Telephone | 501-771-4785
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Fax | 501-771-4787
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Provider Business Mailing Address
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Address Line | 2501 CRESTWOOD RD SUITE 101
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7615
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Country | US
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Telephone | 501-771-4785
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Fax | 501-771-4787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 87
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License Number State | AR
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