JACK BOWEN GILLISON (NPI# 1992225072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992225072 |
| Entity Type | Individual |
| Full Name | JACK BOWEN GILLISON |
| Practice Address |
4253 N Crossover Rd Fayetteville AR 72703-4593 |
| Practice Telephone | 4794428577 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2017-06-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
4253 N CROSSOVER RD |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-4593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689617417 | Norman I Snyder | Psychiatry & Neurology | 4253 N Crossover Rd, Suite 2, Fayetteville, AR 72703-4593 | 2006-06-13 |
| 1770184228 | Eleanor Mcdonald | Pharmacist | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2020-11-02 |
| 1891346664 | Miriam Elyse Koesy | Nurse Practitioner | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2019-09-24 |
| 1760965008 | Jessica Musgrove | Nurse Practitioner | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2018-09-12 |
| 1790282879 | Aprn Medical LLC | Clinic/Center | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2018-04-06 |
| 1578064812 | Kaley Md Mhs Inc | Psychiatry & Neurology | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2018-02-22 |
| 1811418403 | Courtenay Gillett | Behavior Technician | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2017-07-05 |
| 1225559966 | Breanna Noelle Hutchings | Behavior Technician | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2017-07-03 |
| 1659800092 | Angela Kay Thompson-neeser | Case Manager/Care Coordinator | 4253 N Crossover Rd, Fayetteville, AR 72703 | 2017-06-08 |
| 1801324868 | Stephanie Charlene Smith | Case Manager/Care Coordinator | 4253 N Crossover Rd, Fayetteville, AR 72703-4593 | 2017-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| 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 |
|---|---|---|---|---|
| 1700495595 | Brittany Huerta | Case Manager/Care Coordinator | 5649 Gatewood Rd, Fayetteville, WV 25840-5135 | 2020-07-28 |
| 1508474867 | Anna L Kincaid | Case Manager/Care Coordinator | 1257 Terry Ave, Fayetteville, WV 25840-5444 | 2020-07-22 |
| 1619501087 | 1 Source Senior Care | Case Manager/Care Coordinator | 1820 Shelby Ln, Fayetteville, AR 72704-5255 | 2020-02-25 |
| 1326679473 | Megan Thomas | Case Manager/Care Coordinator | 3715 N Business Dr Ste 201, Fayetteville, AR 72703-5288 | 2020-01-28 |
| 1275172298 | Kelsy Timas | Case Manager/Care Coordinator | 143 Skateway Dr, Fayetteville, NC 28304-2640 | 2019-12-23 |
| 1679131726 | Scharmane Porter | Case Manager/Care Coordinator | 110 Westbridge Cir, Fayetteville, GA 30214-2638 | 2019-06-04 |
| 1790259117 | Mackenzie Birdsong | Case Manager/Care Coordinator | 3715 N Business Dr Ste 105, Fayetteville, AR 72703-5287 | 2019-01-18 |
| 1134659162 | Sheila May Reynolds | Case Manager/Care Coordinator | 1872 N Cannondale Dr, Fayetteville, AR 72704-6931 | 2017-06-13 |
| 1528596285 | Alexander Garcia II | Case Manager/Care Coordinator | 1687 W Lodge Way Apt 100a, Fayetteville, AR 72701-5084 | 2017-05-25 |
| 1619414786 | Markese Ware | Case Manager/Care Coordinator | 3715 N Business Dr, Ste 104, Fayetteville, AR 72703-5204 | 2017-01-26 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
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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.