Individual
JAKE MCMILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1015 W KINGSHIGHWAY, PARAGOULD, AR 72450-4142
(870) 239-4076
(870) 239-4079
Mailing address
1015 W KINGSHIGHWAY, PARAGOULD, AR 72450-4142
(870) 239-4076
(870) 239-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-11120
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213955795
—
AR
Enumeration date
03/22/2016
Last updated
06/17/2019
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