Individual
DR. JIMMY DAVID ACKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
612 S 12TH ST, FORT SMITH, AR 72901-4702
(479) 785-2431
(479) 494-7787
Mailing address
612 S 12TH ST, FORT SMITH, AR 72901-4702
(479) 785-2431
(479) 494-7787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-6363
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05508082
—
MS
01
—
077391301
MEDICAID
TX
01
—
080072068
RAILROAD MEDICARE
AR
05
—
100071990A
—
OK
01
—
100267820A
MEDICAID
KS
05
—
110763001
—
AR
01
—
13803000000
QUALCHOICE
AR
05
—
1632163
—
LA
01
—
1899432
UNITED HEALTHCARE
AR
01
—
4627033
AETNA
—
01
—
50026
BLUE CROSS/BLUE SHIELD
AR
01
—
6019495001
CIGNA
—
01
—
913056000
MEDICAID
FL
Enumeration date
06/09/2005
Last updated
03/07/2023
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