Individual
KATRINA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
500 S. UNIVERSITY, SUITE 505, LITTLE ROCK, AR 72205-5307
(501) 664-4532
(501) 663-4335
Mailing address
500 S. UNIVERSITY, SUITE 505, LITTLE ROCK, AR 72205-5307
(501) 664-4532
(501) 663-4335
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
C00815
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C00815
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S440
AR BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/11/2006
Last updated
03/02/2010
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