Individual
DR. JACKIE R WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 N WALNUT, IMBODEN, AR 72434
(870) 869-3101
(870) 869-3014
Mailing address
PO BOX 128, 201 N WALNUT, IMBODEN, AR 72434
(870) 869-3101
(870) 869-3014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C5252
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710836669002
PRUDENTIAL
—
01
—
7182132
AETNA
—
Enumeration date
08/02/2006
Last updated
07/08/2007
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