Individual
LAURA LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2630 E CITIZENS DR STE 3, FAYETTEVILLE, AR 72703-4797
(479) 527-9966
(479) 527-9677
Mailing address
2630 E CITIZENS DR STE 3, FAYETTEVILLE, AR 72703-4797
(479) 527-9966
(479) 527-9677
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190941795
—
AR
05
—
200616270A
—
OK
Enumeration date
09/29/2009
Last updated
01/21/2021
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