Provider Demographics
NPI:1104819358
Name:CUMMINGS, JERRIE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:JERRIE
Middle Name:ANN
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-3279
Mailing Address - Country:US
Mailing Address - Phone:870-946-8400
Mailing Address - Fax:870-946-8511
Practice Address - Street 1:317 W 7TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3279
Practice Address - Country:US
Practice Address - Phone:870-946-8400
Practice Address - Fax:870-946-8511
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150837742Medicaid
AR123614721Medicaid
AR71084878830OtherQUALCHOICE
AR139762742Medicaid
AR123614721Medicaid