Janissa D Jackson in Fayetteville - Clinical
Janissa D Jackson - NPI 1043365620
Janissa D Jackson is a Clinical in Fayetteville, Arkansas. Janissa D Jackson practices all healthcare services and medical treatments related to Clinical. The NPI Number for Janissa D Jackson is 1043365620. The last update date is 2008-02-27.
Janissa D Jackson's current location address is 1 W Sunbridge Dr, Fayetteville, Arkansas. You can contact this provider via phone number 4794435575 and fax number 4794439554. The mailing address for Janissa D Jackson is 1 W Sunbridge Dr, Fayetteville, Arkansas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Janissa D Jackson |
|---|---|
| Address | 1 W Sunbridge Dr, Fayetteville, Arkansas |
| Phone Number | 4794435575 |
| Fax Number | 4794439554 |
| Sole Proprietor | Y |
| Credentials | PHD |
NPI Number Detail
| NPI Number | 1043365620 |
|---|---|
| Provider Enumeration Date | 2007-01-24 |
| Last Updated Date | 2008-02-27 |
Provider Mailing Address Detail
| Address | 1 W Sunbridge Dr |
|---|---|
| City | Fayetteville |
| State | Arkansas (AR) |
| Post Code | 727031825 |
| Phone Number | 4794435575 |
| Fax Number | 4794439554 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 07-01P |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5A252 | AR | BLUECROSS BLUESHIELD |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Janissa D Jackson by the Centers for Medicare & Medicaid Services?
The Janissa D Jackson has been issued the NPI (National Provider Identifier) 1043365620, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Janissa D Jackson is geographically located?
The Janissa D Jackson is physically situated at the following location: 1 W Sunbridge Dr, Fayetteville, AR, 727031825.
What is the Janissa D Jackson's specialty and taxonomy code?
The Janissa D Jackson's specialty is Clinical, and the corresponding taxonomy code is 103Tc0700X.
On what date was the 1043365620 assigned to Janissa D Jackson?
The Janissa D Jackson was issued its 1043365620 on 2007-01-24, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the information regarding Janissa D Jackson most recently updated?
The details pertaining to the Janissa D Jackson, including its address, specialty, and other relevant information, were last refreshed on 2008-02-27.
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