Provider Demographics
NPI:1386868545
Name:CHISM, JESSICA SHORT (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHORT
Last Name:CHISM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0550
Mailing Address - Country:US
Mailing Address - Phone:479-463-7775
Mailing Address - Fax:479-463-7187
Practice Address - Street 1:3276 N NORTHHILLS BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4005
Practice Address - Country:US
Practice Address - Phone:479-404-2300
Practice Address - Fax:479-404-2301
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-10-16
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Provider Licenses
StateLicense IDTaxonomies
ARE-5421207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440106901Medicaid