Individual
DR. NEDRA CLEM JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
900 N 7TH ST, WEST MEMPHIS, AR 72301-2001
(870) 735-3842
(870) 394-4872
Mailing address
900 N 7TH ST, WEST MEMPHIS, AR 72301-2001
(870) 735-3842
(870) 394-4872
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
21180
MS
207Q00000X
Family Medicine Physician
Primary
E-11062
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07989840
—
MS
01
—
302I112036
CMS CAHABA
—
Enumeration date
09/15/2006
Last updated
01/04/2018
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