Provider Demographics
NPI:1982704532
Name:FOX, JESSICA B (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2301 SPRINGHILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7568
Mailing Address - Country:US
Mailing Address - Phone:501-315-0078
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:2301 SPRINGHILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7568
Practice Address - Country:US
Practice Address - Phone:501-315-0078
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-4299208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158395001Medicaid
AR5N339Medicare PIN
AR158395001Medicaid