Healthcare Provider Details

I. General information

NPI: 1003288044
Provider Name (Legal Business Name): JANNA L JENNINGS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 HIGHWAY 5 N
BENTON AR
72019-8559
US

IV. Provider business mailing address

610 HIGHWAY 5 N
BENTON AR
72019-8559
US

V. Phone/Fax

Practice location:
  • Phone: 501-794-2269
  • Fax: 501-794-2229
Mailing address:
  • Phone: 501-794-2269
  • Fax: 501-794-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMC-3133
License Number StateAR

VIII. Authorized Official

Name: DR. JANNA L JENNINGS
Title or Position: OWNER, PEDIATRICIAN
Credential: M.D.
Phone: 501-794-2269