Individual
CHRISSY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QBHP
Contact information
Practice address
2005 W ELM ST, ROGERS, AR 72758-4018
(479) 636-0083
(479) 636-0144
Mailing address
2885 W BATTLEFIELD ST, SPRINGFIELD, MO 65807-3952
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231304795
—
AR
Enumeration date
04/26/2011
Last updated
03/30/2021
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