Jackson, Audra M
Jackson, Audra M is an individual health care provider with primary practice located at 3808 South Gary , Fort Smith AR 72903-5450. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Jackson, Audra M can be contacted via phone (479) 709-7120.Contact Information
Primary practice address
3808 South Gary
Fort Smith AR 72903-5450
Phone: (479) 709-7120
Fax: (479) 709-7123
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | E6098 | Arkansas |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X |
Profile Details
| NPI number | 1093815268 |
|---|---|
| LBN Legal business name | Jackson, Audra M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Aug 23rd, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093815268 | NPPES |
| Oklahoma | MEDICAID | 200231990A |
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