Provider Demographics
NPI:1588967129
Name:FAULKNER, JASON RAY (MHPP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:RAY
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1020 VILLAGE DR
Mailing Address - Street 2:APT 20
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-2932
Mailing Address - Country:US
Mailing Address - Phone:870-451-3979
Mailing Address - Fax:870-230-8201
Practice Address - Street 1:2506 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-2930
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator