Provider Demographics
NPI:1427030295
Name:KARKOS, JERIE BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JERIE
Middle Name:BETH
Last Name:KARKOS
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 1:519 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8360
Mailing Address - Country:US
Mailing Address - Phone:479-750-0125
Mailing Address - Fax:479-750-0323
Practice Address - Street 1:519 LATHAM DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8360
Practice Address - Country:US
Practice Address - Phone:479-750-0125
Practice Address - Fax:479-750-0323
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0621912080P0008X
WI51024-202080P0008X
ARN-82142080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122174001Medicaid
IL036-062191Medicaid
E18988Medicare UPIN
IL036-062191Medicaid
AR122174001Medicaid