Provider Demographics
NPI:1265447171
Name:JARRARD, KRISTIN A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:JARRARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 602A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-221-1311
Mailing Address - Fax:501-225-0627
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:602A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-221-1311
Practice Address - Fax:501-225-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4846208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00370756OtherRAILROAD MEDICARE
06090021210OtherQUALCHOICE
ARE4846OtherSTATE LICENSE
AR5N617OtherBCBS
P00370756OtherRAILROAD MEDICARE
5N617Medicare ID - Type Unspecified