BRENDA SUE JACKSON (NPI# 1467631556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467631556 |
| Entity Type | Individual |
| Full Name | BRENDA SUE JACKSON |
| Credential | MHPP |
| Practice Address |
2508 S.e. 20th Bentonville AR 72712 |
| Mailing Address |
2400 S. 48th St Springdale AR 72762 |
| Practice Telephone | 4797502020 |
| Practice Fax Number | 4798722441 |
| Mailing Telephone | 4797502020 |
| Mailing Fax Number | 4797508967 |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2011-06-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | AR | Other Service Providers | |
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538653498 | Brenda Jean Jackson | Technician | 807 Dillon Ave, New Aiken, SC 29801 | 2018-06-14 |
| 1205225349 | Brenda Lee Jackson | Nurse Practitioner | 757 W Eisenhower Rd, Lansing, KS 66043-2215 | 2015-01-13 |
| 1588179501 | Brenda Jackson | Counselor | 770 Woodlane Rd, Westampton, NJ 08060-3804 | 2017-12-13 |
| 1083060610 | Brenda L.e. Jackson | Occupational Therapist | 601 W Leota St, North Platte, NE 69101-6525 | 2016-05-12 |
| 1578972600 | Brenda Rene Jackson | Counselor | 1555 E Flamingo Rd, Ste. # 158, Las Vegas, NV 89119-5258 | 2014-08-01 |
| 1538509526 | Brenda Jackson | Behavioral Analyst | 5135 Camino Al Norte, Suite 255, North Las Vegas, NV 89031-2387 | 2013-07-05 |
| 1215372644 | Brenda Lee Jackson | Registered Nurse | 530 Hornady Dr, Monroeville, AL 36460-8658 | 2013-04-29 |
| 1326273707 | Brenda Ann Jackson | Radiologic Technologist | 100 Lake Traverse Dr, Sisseton, SD 57262-7046 | 2009-05-28 |
| 1336295286 | Brenda A L Jackson | Nurse Practitioner | 45-602 Kamehameha Hwy, Kaneohe, HI 96744-2017 | 2007-01-25 |
| 1922042951 | Brenda D Jackson | Nurse Practitioner | 1600 Coit Rd Ste 104, Plano, TX 75075-6171 | 2006-06-16 |
| Street Address |
2508 S.E. 20TH |
| City | BENTONVILLE |
| State | AR |
| Zip Code | 72712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558679910 | Melissa Bedford | Counselor | 2508 S.e. 20th, Bentonville, AR 72712 | 2010-09-20 |
| 1710138029 | Leah Rachel Powers | Counselor | 2508 S.e. 20th, Bentonville, AR 72712 | 2008-10-06 |
| 1770763807 | Alexandra Nicole Powell | Case Manager/Care Coordinator | 2508 S.e. 20th, Bentonville, AR 72712 | 2007-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1942837059 | Amy Crumpton | Counselor | 3504 Se Riveria Road, Bentonville, AR 72712 | 2020-03-26 |
| 1295361509 | Unbridled Holdings LLC | Physical Therapy Assistant | 9900 Price Coffee Rd, Bentonville, AR 72712 | 2020-03-18 |
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1740746635 | Meredith C Hodges | Counselor | 2508 Se 2oth St, Bentonville, AR 72712 | 2019-02-15 |
| 1609352566 | Tripharma Inc | Pharmacy | 3500 Sw Regional Airport Blvd Ste 2, Bentonville, AR 72712 | 2018-07-13 |
| 1811406747 | Upspring Therapy, LLC | Counselor | 2106 Sw Walton Blvd, Suite B, Bentonville, AR 72712 | 2017-09-22 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1508399502 | Rosanna Nicole Rephan | Nurse Practitioner | 3101 14th St, Mercy Convenient Care, Bentonville, AR 72712 | 2017-04-06 |
| 1417305517 | Charlotte Lennette Stephenson | Behavioral Analyst | 2005 S.e. Walton Blvd., Bentonville, AR 72712 | 2016-05-31 |
| Find all providers in zip 72712 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326524893 | Austin B Larey | Case Manager/Care Coordinator | 1007 Beau Terre Dr Ste 206, Bentonville, AR 72712-6738 | 2018-07-17 |
| 1407375181 | Kaitlyn M Carlson | Case Manager/Care Coordinator | 1007 Beau Terre Dr Ste 406, Bentonville, AR 72712-6798 | 2017-09-14 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1235681073 | Micah Roberts | Case Manager/Care Coordinator | 2005 Se Walton Boulevard, Bentonville, AR 72712-0000 | 2016-10-27 |
| 1255790168 | Baldo Sanchez | Case Manager/Care Coordinator | 1303 Convair St, Bentonville, AR 72712-6566 | 2016-02-19 |
| 1750759288 | Donna Turner | Case Manager/Care Coordinator | 1005 Beau Terre Dr, Suite 308, Bentonville, AR 72712-6738 | 2015-09-15 |
| 1306246459 | Yander Reyes | Case Manager/Care Coordinator | 2005 Se Walton Blvd., Bentonville, AR 72712 | 2014-08-26 |
| 1023426681 | Charles Eric Freeman | Case Manager/Care Coordinator | 2005 S E Walton Blvd, Bentonville, AR 72712 | 2014-07-28 |
| 1568881019 | David Campbell | Case Manager/Care Coordinator | 2005 S Walton Blvd, Bentonville, AR 72712 | 2014-04-14 |
| 1891915393 | Perla Guadalupe Vasquez | Case Manager/Care Coordinator | 2508 S. E. 20th Street, Bentonville, AR 72712 | 2007-04-26 |
| Find all providers in BENTONVILLE | ||||
| City | BENTONVILLE |
| Zip Code | 72712 |
Please comment or provide details below to improve the information on BRENDA SUE JACKSON.
| 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.