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Contact Information

WILLIE D T JACKSON
1310 S LINDEN ST
PINE BLUFF, AR71603-3347
 Phone: 870-360-1777
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapy Assistant

224Z00000X
 

Dental Assistant

126800000X
Indicates primary specialty

NPI Profile & details for WILLIE D T JACKSON · (Female)

NPI Number 1225717515
Status Active
Credentials
Entity Individual
Enumeration date 07/13/2023
Last updated 07/13/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • AR License # LLC-15810
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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