Individual
KIM JAQUISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNP
Contact information
Practice address
1500 DODSON AVE, STE 125, FORT SMITH, AR 72901-5182
(479) 573-7960
(479) 573-7961
Mailing address
PO BOX 402319, ATLANTA, GA 30384-2319
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
P01373
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013980A
—
OK
05
—
155652741
—
AR
Enumeration date
10/12/2005
Last updated
08/27/2010
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