Provider Demographics
NPI:1346293974
Name:ADKISSON, JARROD R (MD)
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:R
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 6430
Mailing Address - Street 2:2400 S. 48TH
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762
Mailing Address - Country:US
Mailing Address - Phone:479-750-2020
Mailing Address - Fax:479-750-8967
Practice Address - Street 1:2400 S. 48TH
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762
Practice Address - Country:US
Practice Address - Phone:479-750-2020
Practice Address - Fax:479-750-8967
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-84122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8168000000OtherQUALCHOICE QCA
AR135993001Medicaid
AR7463260OtherAETNA
ARBLUE CROSSOther5L000
G82921Medicare UPIN
AR8168000000OtherQUALCHOICE QCA