Healthcare Provider Details

I. General information

NPI: 1639419427
Provider Name (Legal Business Name): JENNIFER MANSFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GAP RD
BATESVILLE AR
72501-8679
US

IV. Provider business mailing address

PO BOX 2578
BATESVILLE AR
72503-2578
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-8900
  • Fax: 870-793-8959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR092894
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: