Individual ProviderBradley JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address634 W Main St, Blytheville, AR 72315-3336(870) 780-6986PECOS EnrollmentBased on the most recent information from CMS, provider Bradley Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1467738195Provider TypeIndividualFull NameJackson, BradleyCredentialMHPPGenderMaleSole ProprietorNoEnumeration Date10/26/2011Last Updated10/26/2011Contact InformationPractice LocationPractice Address634 W Main St, Blytheville, AR 72315-3336Phone(870) 780-6986Fax(870) 870-6987Mailing LocationMailing Address634 W Main St, Blytheville, AR 72315-3336Phone(870) 780-6986Fax(870) 870-6987Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer