Healthcare Provider Details

I. General information

NPI: 1467436725
Provider Name (Legal Business Name): JARRETT BOYD LEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 HIGHWAY 5 N
BRYANT AR
72022-7005
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0289
  • Fax: 501-847-8748
Mailing address:
  • Phone: 501-847-0289
  • Fax: 501-847-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-4782
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE4782
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: