JONATHAN RASHAD HABERSHAM (NPI# 1174045868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174045868 |
| Entity Type | Individual |
| Full Name | JONATHAN RASHAD HABERSHAM |
| Practice Address |
1255 Vandenberg Dr Jacksonville AR 72099-4942 |
| Mailing Address |
133 Montana Cir Jacksonville AR 72076-1134 |
| Practice Telephone | 5019873080 |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2017-07-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
1255 VANDENBERG DR |
| City | JACKSONVILLE |
| State | AR |
| Zip Code | 72099-4942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356876577 | Little Rock Air Force Base Eye Care | Optometrist | 6th Street, Bldg 787, Little Rock Air Force Base, Little Rock, AR 72099 | 2017-04-25 |
| 1841636206 | National Vision Optical | Technician/Technologist | Bldg 787 6th St., Little Rock, AR 72099 | 2013-05-13 |
| 1134341076 | Keisha Denythia Henry | Psychologist | 314 Medical Group, Life Skills Support Center, 1090 Arnold Drive, Little Rock Afb, AR 72099 | 2007-05-02 |
| 1457810848 | Dennis Dale Jackson II | Pharmacist | 1090 Arnold Dr, Little Rock Afb, AR 72099 | 2019-03-15 |
| 1003319880 | Isaac Clayton Talbert | Preventive Medicine | 1090 Arnold Dr, Jacksonville, AR 72099 | 2018-03-17 |
| 1699213454 | Teryn Ardell Freeman | Physician Assistant | 19th Medical Group, 1090 Arnold Drive, Little Rock, AR 72099 | 2017-02-01 |
| 1437545183 | Christina R Lyon | Family Medicine | 1090 Arnold Dr, Little Rock Air Force Base, AR 72099 | 2015-04-09 |
| 1922362102 | Seth William Heimer | Family Medicine | 1090 Arnold Dr, Lr Afb, AR 72099 | 2012-07-02 |
| 1730314899 | Andrew Chichick Iv | Military Health Care Provider | 1090 Arnold Drive, 19 Amds/sgpf, Little Rock Afb, AR 72099 | 2009-05-19 |
| 1669469094 | Jordan Kieliszewski | Social Worker | 1090 Arnold Dr, Jacksonville, AR 72099 | 2005-09-30 |
| Find all providers in zip 72099 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194932673 | Thomas Harrison Gentry IIi | Military Health Care Provider | 110 Fieldcrest Dr, Jacksonville, NC 28546-9673 | 2007-05-16 |
| 1679025795 | Claudia Irene Sloan | Military Health Care Provider | 1090 Arnold Dr, Jacksonville, AR 72099-4933 | 2016-10-25 |
| 1851703177 | Robert Murray Jr. | Military Health Care Provider | 2080 Child St, Jacksonville, FL 32214-5005 | 2014-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316171994 | Jeff J. Sandoval | Military Health Care Provider | 19 Amds Sgopf, 1090 Arnold Dr, Little Rock Afb, AR 72099-0001 | 2009-05-11 |
| 1407409428 | Jenisha Rae Mermis | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2019-07-18 |
| 1235600461 | Leeanne Elizabeth Ogle | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2018-12-16 |
| 1427351030 | Tiffani Mckee | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2010-12-21 |
| 1730314899 | Andrew Chichick Iv | Military Health Care Provider | 1090 Arnold Drive, 19 Amds/sgpf, Little Rock Afb, AR 72099 | 2009-05-19 |
| 1770718017 | Christopher John Hoar | Military Health Care Provider | 1090 Arnold Dr, Bldg 1090/flight Medicine, Lr Afb, AR 72099-4933 | 2009-05-15 |
| 1487888574 | Tommy Nelson Belcher | Military Health Care Provider | 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 | 2009-05-05 |
| City | JACKSONVILLE |
| Zip Code | 72099 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.