Healthcare Provider Details

I. General information

NPI: 1770267171
Provider Name (Legal Business Name): JENNA MAKENZIE RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 FAYETTEVILLE AVE
ALMA AR
72921-3655
US

IV. Provider business mailing address

344 FAYETTEVILLE AVE
ALMA AR
72921-3655
US

V. Phone/Fax

Practice location:
  • Phone: 479-632-4600
  • Fax:
Mailing address:
  • Phone: 479-632-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90822
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: