Healthcare Provider Details

I. General information

NPI: 1174446264
Provider Name (Legal Business Name): JO DANIELLE CROSS RN
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

2500 S WALDRON RD
FORT SMITH AR
72903-3739
US

IV. Provider business mailing address

2315 N DAVIS ST
LAVACA AR
72941-4515
US

V. Phone/Fax

Practice location:
  • Phone: 479-478-3161
  • Fax: 479-452-7654
Mailing address:
  • Phone: 479-478-3161
  • Fax: 479-452-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR040879
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: