Healthcare Provider Details

I. General information

NPI: 1366990343
Provider Name (Legal Business Name): JENNIFER LYNN PRICE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 S 2ND ST STE E
CABOT AR
72023-7043
US

IV. Provider business mailing address

PO BOX 927
CABOT AR
72023-0927
US

V. Phone/Fax

Practice location:
  • Phone: 501-443-3818
  • Fax: 501-521-1001
Mailing address:
  • Phone: 501-944-4155
  • Fax: 501-286-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAR004876
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAR004876
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: