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General NPI Number Information
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NPI Number | 1699948901
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Entity Type | Individual
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Provider Name | JENNIFER LYNN JACKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 1718 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-7008
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Country | US
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Telephone | 870-534-7546
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Fax | 870-534-2343
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Provider Business Mailing Address
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Address Line | 1710 W 42ND AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603
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Country | US
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Telephone | 870-534-7546
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | E7442
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License Number State | AR
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