Active NPI 1699948901 Individual Practitioner Female Practitioner

Dr. Jennifer Lynn Jacks , MD

Dermatology • Pine Bluff, AR

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jennifer Jacks, MD is a certified Dermatology practicing in Pine Bluff, AR. With approximately 18 years of clinical experience since graduating from University Of Arkansas College Of Medicine in 2008, Dr. Jacks delivers high-quality medical care to the local community at 1718 W 42ND AVE.

Dr. Jacks accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1718 W 42nd Ave

Pine Bluff, AR 716037008

Telephone 8705347546

Fax 8705342343

Associated Practice Facility / Clinic

🏢 Jacks Dermatology P.a. Facility NPI 1558621367

Medicare Profile & Education

Medical School

University Of Arkansas College Of Medicine

Graduation Year

2008

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Pine Bluff, AR

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

18 Yrs Matches City Avg

City Avg: 18.0 Yrs

State Avg: 23.1 Yrs

Regional Practice Density

2 Specialists

Practicing in Pine Bluff, AR (82 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

40.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Jacks (18 Years) 18 Yrs

Pine Bluff Specialty Average (18.0 Years) 18.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,411	626	$8.97	$5.82
99213 Established patient office or other outpatient visit, typically 15 minutes	2,742	1,811	$100.00	$82.10
17000 Destruction of skin growth	1,150	806	$104.54	$52.68
17110 Destruction of up to 14 skin growths	857	685	$175.21	$98.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	530	459	$55.32	$50.76
11102 Tangential biopsy of single skin lesion	477	421	$141.98	$80.46
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	410	325	$139.80	$115.60
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	349	349	$149.83	$100.46
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	109	97	$273.62	$150.34
11103 Biopsy of related skin growth, each additional growth	69	57	$71.09	$41.22
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	67	67	$200.90	$151.60
99202 New patient office or other outpatient visit, typically 20 minutes	60	60	$100.00	$64.73
17004 Destruction of precancer skin growth, 15 or more growths	55	41	$300.00	$147.48
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	53	51	$337.83	$179.37
11104 Punch biopsy, first skin growth	36	35	$163.89	$109.22
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	21	16	$310.00	$155.47
96574 Application of light with debridement to destroy precancer skin growth	18	18	$352.78	$240.76
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	18	18	$600.00	$390.53
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	14	13	$323.21	$144.65
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	14	13	$485.71	$257.61
69100 Biopsy of ear	13	13	$154.69	$71.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,943	592	$8.94	$5.98
99213 Established patient office or other outpatient visit, typically 15 minutes	2,462	1,691	$100.00	$82.55
17000 Destruction of skin growth	1,050	755	$103.93	$52.91
17110 Destruction of up to 14 skin growths	940	742	$174.40	$100.24
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	522	445	$55.39	$51.28
11102 Tangential biopsy of single skin lesion	361	318	$129.29	$83.86
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	347	256	$139.80	$116.42
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	279	279	$149.35	$102.06
99202 New patient office or other outpatient visit, typically 20 minutes	104	104	$99.52	$65.75
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	65	57	$273.46	$153.31
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	62	62	$200.00	$151.55
11103 Biopsy of related skin growth, each additional growth	48	39	$69.17	$45.15
11104 Punch biopsy, first skin growth	44	43	$157.95	$111.37
17004 Destruction of precancer skin growth, 15 or more growths	38	31	$292.11	$151.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,649	654	$9.00	$6.06
99213 Established patient office or other outpatient visit, typically 15 minutes	2,639	1,784	$100.00	$83.39
17000 Destruction of skin growth	1,135	805	$104.97	$50.71
17110 Destruction of up to 14 skin growths	944	778	$175.84	$99.99
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	573	481	$55.41	$51.39
11102 Tangential biopsy of single skin lesion	492	431	$148.24	$83.17
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	386	282	$139.99	$118.28
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	339	339	$150.00	$102.39
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	130	23	$40.00	$13.01
99202 New patient office or other outpatient visit, typically 20 minutes	109	109	$100.00	$66.48
11103 Biopsy of related skin growth, each additional growth	94	73	$74.20	$46.18
17111 Destruction of skin growth, 15 or more growths	87	66	$200.00	$119.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	73	73	$200.27	$154.46
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	56	50	$275.00	$155.03
11104 Punch biopsy, first skin growth	52	51	$175.00	$114.72
17004 Destruction of precancer skin growth, 15 or more growths	52	45	$300.00	$152.81
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	40	31	$10.00	$1.07
11900 Injection into skin growth, 1-7 growths	35	28	$90.00	$44.30
12001 Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs	18	18	$146.33	$44.56
69100 Biopsy of ear	16	15	$160.00	$60.51
11105 Punch biopsy, each additional skin growth	14	14	$85.00	$53.65
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	14	$340.00	$187.26
10040 Acne surgery	14	14	$169.64	$105.10
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	13	11	$600.00	$387.93
40490 Biopsy of lip	13	13	$200.00	$112.62

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,040	578	$8.93	$5.83
99213 Established patient office or other outpatient visit, typically 15 minutes	2,370	1,617	$99.83	$84.15
17000 Destruction of skin growth	1,031	739	$103.19	$50.16
17110 Destruction of up to 14 skin growths	853	678	$171.60	$99.41
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	560	471	$55.52	$51.43
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	470	15	$165.41	$104.16
11102 Tangential biopsy of single skin lesion	464	413	$143.04	$82.16
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	439	327	$138.41	$119.81
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	306	306	$147.13	$102.54
99202 New patient office or other outpatient visit, typically 20 minutes	124	124	$98.19	$66.70
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	122	26	$38.20	$13.01
11103 Biopsy of related skin growth, each additional growth	96	76	$73.44	$46.90
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	70	64	$272.14	$159.28
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	64	54	$10.00	$1.28
17111 Destruction of skin growth, 15 or more growths	63	54	$198.73	$120.27
11104 Punch biopsy, first skin growth	63	59	$167.06	$116.11
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	56	56	$196.43	$155.86
11900 Injection into skin growth, 1-7 growths	53	46	$88.87	$46.48
17004 Destruction of precancer skin growth, 15 or more growths	50	40	$294.00	$150.37
69100 Biopsy of ear	47	41	$157.06	$74.69
10040 Acne surgery	25	25	$169.00	$103.12
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	23	21	$250.00	$122.95
12001 Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs	21	21	$146.81	$44.45
40490 Biopsy of lip	15	14	$194.67	$114.85
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	11	11	$326.36	$188.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,336	650	$6.98	$5.50
99213 Established patient office or other outpatient visit, typically 15 minutes	2,327	1,560	$71.74	$69.76
17000 Destruction of skin growth	1,190	840	$61.79	$48.64
17110 Destruction of up to 14 skin growths	834	686	$102.53	$100.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	442	354	$106.33	$101.29
11102 Tangential biopsy of single skin lesion	431	386	$97.84	$78.80
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	390	19	$105.00	$102.26
99202 New patient office or other outpatient visit, typically 20 minutes	269	269	$75.90	$69.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	246	218	$43.50	$41.72
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	182	182	$103.21	$99.40
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	121	26	$25.45	$13.26
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	106	87	$10.00	$1.43
11900 Injection into skin growth, 1-7 growths	96	78	$59.06	$39.39
99441 Telephone medical discussion with physician, 5-10 minutes	87	87	$20.00	$19.97
11103 Biopsy of related skin growth, each additional growth	77	53	$51.49	$47.71
17111 Destruction of skin growth, 15 or more growths	66	50	$128.33	$118.32
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	65	60	$193.34	$153.17
11104 Punch biopsy, first skin growth	64	61	$128.13	$113.20
17004 Destruction of precancer skin growth, 15 or more growths	59	40	$157.46	$142.61
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	36	36	$206.94	$190.06
69100 Biopsy of ear	31	30	$97.81	$67.53
10040 Acne surgery	27	24	$102.78	$76.67
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	21	20	$150.62	$117.25
G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m servic	20	20	$25.00	$12.70
10060 Simple or single drainage of skin abscess	16	15	$117.75	$105.07
99422 Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes	15	15	$50.00	$26.05
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	13	13	$190.77	$173.25
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	12	12	$188.25	$165.93
12001 Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs	12	12	$117.00	$36.50

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	6,000	30	$1.75	$1.36
17003 Destruction of precancer skin growth, 2-14 growths	3,140	644	$5.33	$5.01
99213 Established patient office or other outpatient visit, typically 15 minutes	2,677	1,710	$70.55	$68.45
17000 Destruction of skin growth	1,135	823	$61.83	$46.65
17110 Destruction of up to 14 skin growths	994	816	$103.10	$97.21
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	488	12	$105.00	$97.72
11102 Tangential biopsy of single skin lesion	487	422	$96.65	$78.01
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	369	284	$106.30	$99.73
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	183	183	$101.84	$99.33
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	149	101	$10.00	$1.58
11900 Injection into skin growth, 1-7 growths	135	85	$50.44	$42.16
99202 New patient office or other outpatient visit, typically 20 minutes	126	126	$75.13	$70.37
11103 Biopsy of related skin growth, each additional growth	99	77	$52.27	$45.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	89	86	$42.44	$41.32
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	58	29	$27.10	$15.28
17111 Destruction of skin growth, 15 or more growths	58	48	$122.41	$117.39
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	50	42	$175.78	$142.40
11104 Punch biopsy, first skin growth	44	43	$125.00	$110.73
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	34	32	$230.00	$113.10
17004 Destruction of precancer skin growth, 15 or more growths	31	26	$139.35	$135.57
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	29	28	$275.52	$272.24
69100 Biopsy of ear	28	26	$93.39	$80.71
96573 Application of light by qualified health care professional to destroy precancer skin growth	27	27	$186.81	$177.67
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	25	24	$190.00	$184.03
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	17	14	$179.71	$145.92
10040 Acne surgery	16	16	$100.00	$89.48
10060 Simple or single drainage of skin abscess	15	14	$130.67	$99.35
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	13	13	$391.54	$386.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	9,602	46	$1.95	$1.44
17003 Destruction of precancer skin growth, 2-14 growths	3,495	648	$10.74	$4.54
99213 Established patient office or other outpatient visit, typically 15 minutes	2,308	1,505	$82.11	$65.16
17000 Destruction of skin growth	1,106	814	$100.79	$46.08
11100 Biopsy of single growth of skin and/or tissue	774	636	$131.54	$81.73
17110 Destruction of up to 14 skin growths	729	607	$137.64	$95.48
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	465	15	$105.00	$95.99
Q4131 Epifix or epicord, per square centimeter	341	19	$175.00	$157.42
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	329	297	$48.81	$38.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	239	186	$129.87	$96.23
99202 New patient office or other outpatient visit, typically 20 minutes	184	184	$90.49	$66.88
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	160	159	$129.43	$96.03
11101 Biopsy of each additional growth of skin and/or tissue	147	120	$46.93	$28.47
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	65	64	$403.08	$258.40
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	58	56	$320.86	$123.82
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	51	47	$205.39	$136.47
96573 Application of light by qualified health care professional to destroy precancer skin growth	51	46	$220.98	$160.48
17004 Destruction of precancer skin growth, 15 or more growths	48	40	$217.29	$127.57
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	46	43	$357.43	$135.29
69100 Biopsy of ear	42	42	$107.86	$69.52
17111 Destruction of skin growth, 15 or more growths	41	35	$170.73	$112.99
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	38	35	$151.32	$97.05
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	36	35	$240.00	$175.60
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	35	31	$600.00	$398.18
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	31	19	$200.00	$88.85
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	26	25	$682.50	$420.10
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	17	$210.53	$79.59
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	19	17	$167.89	$97.51
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	18	15	$10.00	$1.71
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	18	18	$376.11	$139.56
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	17	17	$258.82	$148.20
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	17	16	$535.88	$375.94
40490 Biopsy of lip	17	17	$152.94	$114.16
11900 Injection into skin growth, 1-7 growths	15	14	$52.00	$44.33
67810 Biopsy of eyelid	12	12	$226.25	$150.23
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	12	11	$198.33	$157.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,904	696	$15.00	$4.96
99213 Established patient office or other outpatient visit, typically 15 minutes	1,953	1,362	$90.00	$66.94
17000 Destruction of skin growth	1,138	844	$130.00	$50.21
17110 Destruction of up to 14 skin growths	534	465	$175.00	$95.94
11100 Biopsy of single growth of skin and/or tissue	388	350	$160.00	$81.90
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	377	325	$55.00	$39.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	201	122	$140.00	$97.11
99202 New patient office or other outpatient visit, typically 20 minutes	157	157	$94.20	$67.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	146	146	$150.00	$97.74
17004 Destruction of precancer skin growth, 15 or more growths	82	56	$300.00	$134.11
17111 Destruction of skin growth, 15 or more growths	75	67	$200.00	$113.40
11101 Biopsy of each additional growth of skin and/or tissue	49	43	$60.00	$29.40
10040 Acne surgery	42	41	$175.00	$78.39
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	38	36	$275.00	$151.24
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	36	35	$300.00	$150.90
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	30	28	$340.00	$181.39
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	23	22	$250.00	$108.92
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	19	19	$500.00	$245.74
10060 Simple or single drainage of skin abscess	14	13	$200.00	$106.59
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	13	$400.00	$111.65
17106 Destruction of skin growth (less than 10 sq centimeters)	13	12	$600.00	$310.74

Medical Specialties & State Licenses

CMS Verified: 2020-09-29

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License AR E7442

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners

Jena Shepherd

Nurse Practitioner

NPI 1770136202

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

📍

Updated Practice Location September 29, 2020

Registered at 1718 W 42ND AVE, PINE BLUFF, AR 716037008 (Tel: 8705347546)

✅

NPI Profile Active September 13, 2013

NPI status registered as active in NPPES database

📍

Updated Practice Location September 13, 2013

Registered at 1710 W 42ND AVE, PINE BLUFF, AR 716037008 (Tel: 8707184825)

📍

Updated Business Mailing Address September 13, 2013

Registered at 1710 W 42ND AVE, PINE BLUFF, AR 71603 (Tel: 8705347546)

👤

Provider Name / Credentials Updated September 13, 2013

Recorded as JENNIFER JACKS, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2013

Dermatology (License #E7442 in AR)

🟢

Initial NPI Registration & Enumeration April 08, 2008

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1699948901

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 08, 2008

Last Update: September 29, 2020

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1710 W 42nd Ave

Pine Bluff, AR 71603

Phone: 8705347546

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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