Healthcare Provider Details

I. General information

NPI: 1659848133
Provider Name (Legal Business Name): JESSICA K SEARS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 04/06/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 N. STEELE BLVD UPTOWN SUITE 122
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

3959 N. STEELE BLVD UPTOW
F AR
72703
US

V. Phone/Fax

Practice location:
  • Phone: 479-335-5777
  • Fax:
Mailing address:
  • Phone: 479-335-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP139399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: