Dr Jackie R White, MD is a medicare enrolled "Family Medicine" physician in Imboden, Arkansas. His current practice location is
201 N Walnut, Imboden, Arkansas. You can reach out to his office (for appointments etc.) via phone at
(870) 869-3101.
Dr Jackie R White is licensed to practice in Arkansas (license number C5252) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417964107.
Physician's Profile
Full Name | Dr Jackie R White |
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Gender | Male |
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Speciality | Family Medicine |
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Location | 201 N Walnut, Imboden, Arkansas |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1417964107
- Provider Enumeration Date: 08/02/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 7517146962
- Enrollment ID: I20110201000246
Medical Identifiers
Medical identifiers for Dr Jackie R White such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1417964107 | NPI | - | NPPES |
710836669002 | Other | | PRUDENTIAL |
7182132 | Other | | AETNA |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | C5252 (Arkansas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jackie R White is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Jackie R White, MD Po Box 128, 201 N Walnut, Imboden, AR 72434 Ph: (870) 869-3101 | Dr Jackie R White, MD 201 N Walnut, Imboden, AR 72434 Ph: (870) 869-3101 |
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