Healthcare Provider Details

I. General information

NPI: 1114650322
Provider Name (Legal Business Name): LAUREN JACKSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BOWDEN

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 COUNTRY ACRES RD
ATKINS AR
72823-8400
US

IV. Provider business mailing address

555 COUNTRY ACRES RD
ATKINS AR
72823-8400
US

V. Phone/Fax

Practice location:
  • Phone: 479-264-4591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221070
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: