Individual
AUDRA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3808 SOUTH GARY, FORT SMITH, AR 72903-5450
(479) 709-7120
(479) 709-7123
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E6098
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200231990A
—
OK
Enumeration date
09/25/2006
Last updated
08/23/2010
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