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Individual

MS. AMANDA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
300 WERNER ST, HOT SPRINGS, AR 71913-6406
(501) 664-4532
Mailing address
6119 MIDTOWN AVE STE 201, LITTLE ROCK, AR 72205-5316

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R094191
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
121349
AR

Other

Enumeration date
04/15/2019
Last updated
07/10/2019
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