Individual
MR. DERRICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
177 BUSH STREET, BUILDING 77, HUGHES, AR 72348
(870) 339-3701
(870) 339-3941
Mailing address
703 CALVIN AVERY DR, SUITE A, WEST MEMPHIS, AR 72301-6501
(870) 732-1878
(870) 702-7111
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/13/2013
Last updated
09/13/2013
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