Provider Demographics
NPI:1689037004
Name:JACKSON, MYNHAN HUYNH (MD)
Entity Type:Individual
Prefix:DR
First Name:MYNHAN
Middle Name:HUYNH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NHANMY
Other - Middle Name:THI
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1002 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8610
Mailing Address - Country:US
Mailing Address - Phone:479-338-3750
Mailing Address - Fax:479-338-3799
Practice Address - Street 1:1002 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-338-3750
Practice Address - Fax:479-338-3799
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE12143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine