Healthcare Provider Details

I. General information

NPI: 1679627673
Provider Name (Legal Business Name): JENNIFER MICHELLE CAUSEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 PINE ST
ARKADELPHIA AR
71923-4335
US

IV. Provider business mailing address

1517 O CONNELL ST.
ARKADELPHIA AR
71923
US

V. Phone/Fax

Practice location:
  • Phone: 870-245-2210
  • Fax:
Mailing address:
  • Phone: 256-648-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR77372
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: