Provider Demographics
NPI:1730508847
Name:FISK, JARED
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:FISK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6600
Mailing Address - Country:US
Mailing Address - Phone:870-245-2210
Mailing Address - Fax:870-245-2225
Practice Address - Street 1:1715 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-6600
Practice Address - Country:US
Practice Address - Phone:870-245-2210
Practice Address - Fax:870-245-2225
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator