Healthcare Provider Details

I. General information

NPI: 1598570426
Provider Name (Legal Business Name): JESSICA RENEE VASQUEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ROGERS AVE
FORT SMITH AR
72901-4164
US

IV. Provider business mailing address

2420 ROGERS AVE
FORT SMITH AR
72901-4164
US

V. Phone/Fax

Practice location:
  • Phone: 479-782-0244
  • Fax: 479-226-3148
Mailing address:
  • Phone: 479-782-0244
  • Fax: 479-226-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230734
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: