Individual
DR. MARTHA A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2501 CRESTWOOD RD, SUITE 101, NORTH LITTLE ROCK, AR 72116-7615
(501) 771-4785
(501) 771-4787
Mailing address
2501 CRESTWOOD RD, SUITE 101, NORTH LITTLE ROCK, AR 72116-7615
(501) 771-4785
(501) 771-4787
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
87
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0580220001
PALMETTO DME
—
05
—
110420717
—
AR
01
—
16253000040
QUAL CHOICE
AR
01
—
2720028
UNITED HEALTH CARE
—
01
—
56243
FEP BCBS
AR
01
—
5997156
AETNA
—
01
—
9468520001
CIGNA
—
Enumeration date
03/30/2006
Last updated
07/14/2020
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