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1427020882 NPI number — CAROLE LYNN JACKSON MD

NPI Number: 1427020882
Health Care Provider/Practitioner: CAROLE LYNN JACKSON MD

Information about “1427020882” NPI (CAROLE LYNN JACKSON MD) exists in 1427020882 in HTML format HTML  |  1427020882 in plain Text format TXT  |  1427020882 in PDF (Portable Document Format) PDF  |  1427020882 in an XML format XML  formats.

NPI Number : 1427020882 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427020882",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "CAROLE",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2519 COLLEGE AVENUE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONWAY",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72034-6135",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-327-6547",
    "MailingAddressFaxNumber": "501-327-9715",
    "FirstLinePracticeLocationAddress": "525 WESTERN AVENUE",
    "SecondLinePracticeLocationAddress": "SUITE 303",
    "PracticeLocationAddressCityName": "CONWAY",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72034-6135",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "501-327-9497",
    "PracticeLocationAddressFaxNumber": "501-327-3478",
    "EnumerationDate": "02/01/2006",
    "LastUpdateDate": "03/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207V00000X",
        "TaxonomyName": "Obstetrics & Gynecology Physician",
        "LicenseNumber": "C 5812",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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