Healthcare Provider Details

I. General information

NPI: 1154244143
Provider Name (Legal Business Name): JENNIFER RATELIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SPIRIT DR
CABOT AR
72023-2731
US

IV. Provider business mailing address

16160 HIGHWAY 31 N
WARD AR
72176-8894
US

V. Phone/Fax

Practice location:
  • Phone: 501-743-3576
  • Fax:
Mailing address:
  • Phone: 501-538-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR079213
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: