Healthcare Provider Details

I. General information

NPI: 1043899503
Provider Name (Legal Business Name): JESSIE LITTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HWY 65 NORTH SUITE 110
HARRISON AR
72601
US

IV. Provider business mailing address

620 N MAIN ST
HARRISON AR
72601-2911
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4022
  • Fax: 870-414-2023
Mailing address:
  • Phone: 870-414-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-17273
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: