Provider Demographics
NPI:1558244756
Name:JACKSON, DENISHIA NICOLE
Entity type:Individual
Prefix:MRS
First Name:DENISHIA
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DENISHIA
Other - Middle Name:NIOOLE
Other - Last Name:JYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10681 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8764
Mailing Address - Country:US
Mailing Address - Phone:402-810-4360
Mailing Address - Fax:
Practice Address - Street 1:10681 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8764
Practice Address - Country:US
Practice Address - Phone:402-810-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050590060716R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide