Basic Information
| Provider Information | |||||||||
| NPI: | 1437342052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKMAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016271800 | ||||||||
| FaxNumber: | 5016271899 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MERCY LANE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016092229 | ||||||||
| FaxNumber: | 5013214057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ARE6415 | AR | Y | Allopathic & Osteopathic Physicians | Surgery | 282N00000X | 390200000X | AR | N | Hospitals | General Acute Care Hospital | 282N00000X | FL | N | Hospitals | General Acute Care Hospital |
No ID Information.