Individual
BRIAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
455 HOGAN LN, CONWAY, AR 72034-8201
(501) 513-0799
Mailing address
119 HARMONY LOOP, MAUMELLE, AR 72113-7070
(501) 206-1492
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
225272
AR
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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