Healthcare Provider Details

I. General information

NPI: 1902740558
Provider Name (Legal Business Name): JINNI WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E APPLEBY RD STE 302
FAYETTEVILLE AR
72703-3160
US

IV. Provider business mailing address

3 E APPLEBY RD STE 302
FAYETTEVILLE AR
72703-3160
US

V. Phone/Fax

Practice location:
  • Phone: 479-404-1400
  • Fax: 479-404-1401
Mailing address:
  • Phone: 479-404-1400
  • Fax: 479-404-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: