MR. MARLIN TYLER JACKSON (NPI# 1396123667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396123667 |
| Entity Type | Individual |
| Full Name | MR. MARLIN TYLER JACKSON |
| Credential | B.A. |
| Practice Address |
2005 Se Walton Blvd Bentonville AR 72712 |
| Mailing Address |
1002 N Flamingo Rd Rogers AR 72756-1910 |
| Practice Telephone | 4794645925 |
| Practice Fax Number | 4794644275 |
| Mailing Telephone | 8702195696 |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
2005 SE WALTON BLVD |
| City | BENTONVILLE |
| State | AR |
| Zip Code | 72712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821182510 | Julie Marie Scott | Social Worker | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2006-10-03 |
| 1174049993 | Melina Callaway | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2017-08-15 |
| 1902322720 | Chealsey Kay Powell | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2017-08-15 |
| 1245779982 | Bailey Stephens | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2017-02-14 |
| 1336688282 | Satyn Barnes-turner | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2017-02-13 |
| 1811449309 | Sarah Sloan | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2016-10-31 |
| 1679025324 | Marymargaret Portera | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72714 | 2016-10-28 |
| 1194277855 | Hailey Martinez | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2016-10-28 |
| 1912305053 | Emily Hedrick | Counselor | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2014-12-05 |
| 1760883599 | Heather Allen | Case Manager/Care Coordinator | 2005 Se Walton Blvd, Bentonville, AR 72712 | 2014-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1942837059 | Amy Crumpton | Counselor | 3504 Se Riveria Road, Bentonville, AR 72712 | 2020-03-26 |
| 1295361509 | Unbridled Holdings LLC | Physical Therapy Assistant | 9900 Price Coffee Rd, Bentonville, AR 72712 | 2020-03-18 |
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1740746635 | Meredith C Hodges | Counselor | 2508 Se 2oth St, Bentonville, AR 72712 | 2019-02-15 |
| 1609352566 | Tripharma Inc | Pharmacy | 3500 Sw Regional Airport Blvd Ste 2, Bentonville, AR 72712 | 2018-07-13 |
| 1811406747 | Upspring Therapy, LLC | Counselor | 2106 Sw Walton Blvd, Suite B, Bentonville, AR 72712 | 2017-09-22 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1508399502 | Rosanna Nicole Rephan | Nurse Practitioner | 3101 14th St, Mercy Convenient Care, Bentonville, AR 72712 | 2017-04-06 |
| 1417305517 | Charlotte Lennette Stephenson | Behavioral Analyst | 2005 S.e. Walton Blvd., Bentonville, AR 72712 | 2016-05-31 |
| Find all providers in zip 72712 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326524893 | Austin B Larey | Case Manager/Care Coordinator | 1007 Beau Terre Dr Ste 206, Bentonville, AR 72712-6738 | 2018-07-17 |
| 1407375181 | Kaitlyn M Carlson | Case Manager/Care Coordinator | 1007 Beau Terre Dr Ste 406, Bentonville, AR 72712-6798 | 2017-09-14 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1235681073 | Micah Roberts | Case Manager/Care Coordinator | 2005 Se Walton Boulevard, Bentonville, AR 72712-0000 | 2016-10-27 |
| 1255790168 | Baldo Sanchez | Case Manager/Care Coordinator | 1303 Convair St, Bentonville, AR 72712-6566 | 2016-02-19 |
| 1750759288 | Donna Turner | Case Manager/Care Coordinator | 1005 Beau Terre Dr, Suite 308, Bentonville, AR 72712-6738 | 2015-09-15 |
| 1306246459 | Yander Reyes | Case Manager/Care Coordinator | 2005 Se Walton Blvd., Bentonville, AR 72712 | 2014-08-26 |
| 1023426681 | Charles Eric Freeman | Case Manager/Care Coordinator | 2005 S E Walton Blvd, Bentonville, AR 72712 | 2014-07-28 |
| 1568881019 | David Campbell | Case Manager/Care Coordinator | 2005 S Walton Blvd, Bentonville, AR 72712 | 2014-04-14 |
| 1467631556 | Brenda Sue Jackson | Case Manager/Care Coordinator | 2508 S.e. 20th, Bentonville, AR 72712 | 2007-10-25 |
| Find all providers in BENTONVILLE | ||||
| City | BENTONVILLE |
| Zip Code | 72712 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.