Provider Demographics
NPI:1285191635
Name:JACKMAN, AARON RAY (APRN PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:RAY
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 S 2750 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9319
Mailing Address - Country:US
Mailing Address - Phone:385-309-4049
Mailing Address - Fax:
Practice Address - Street 1:3400 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3120
Practice Address - Country:US
Practice Address - Phone:254-342-0222
Practice Address - Fax:254-342-0202
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8646793-44052084P0800X
TXAP145836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry