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Individual

ANDREA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2120 S WALDRON RD STE C, FORT SMITH, AR 72903-3689
(479) 452-0424
Mailing address
13364 HIGHWAY 219, OZARK, AR 72949-8939
(479) 209-2545

Taxonomy

Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
PTA2294
AR

Other

Enumeration date
11/06/2024
Last updated
11/06/2024
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