Provider Demographics
NPI:1821606302
Name:AMOS, JACOBIE (QBHP)
Entity Type:Individual
Prefix:
First Name:JACOBIE
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARDIN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3507
Mailing Address - Country:US
Mailing Address - Phone:501-603-2147
Mailing Address - Fax:501-603-0324
Practice Address - Street 1:400 HARDIN RD STE 150
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3507
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:501-603-0324
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator