# JIMMERSON FAMILY HEALTH CARE P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649496357
- **Authorized official:** DR. ROBERT TYRAY JIMMERSON II M.D. (PHYSICIAN)
- **Authorized official phone:** (501) 569-9961

## Contact information

- **Practice address:** 6917 GEYER SPRINGS RD, SUITE 4S, LITTLE ROCK, AR 72209-2727
- **Practice address phone:** (501) 569-9961
- **Practice address fax:** (501) 569-9903
- **Mailing address:** 6917 GEYER SPRINGS RD, SUITE 4S, LITTLE ROCK, AR 72209-2727
- **Mailing address phone:** (501) 569-9961
- **Mailing address fax:** (501) 569-9903

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E-1845 | AR | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 05/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080158974 | PALMETTOGBA | AR |
| 05 | — | 135241001 | — | AR |
| 01 | — | 18321000000 | QUAL CHOICE | AR |
| 01 | — | 2451550 | AETNA | — |
| 01 | — | 2717169 | CIGNA | — |
| 01 | — | 5K890 | BCBS | AR |