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General NPI Number Information
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NPI Number | 1386868545
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Entity Type | Individual
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Provider Name | JESSICA SHORT CHISM MD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3276 N NORTHHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4005
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Country | US
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Telephone | 479-404-2300
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Fax | 479-404-2301
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | LOWELL
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State | AR
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Zip | 72745-0550
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Country | US
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Telephone | 479-463-7775
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Fax | 479-463-7187
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | E-5421
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License Number State | AR
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