Healthcare Provider Details

I. General information

NPI: 1124737739
Provider Name (Legal Business Name): JESSIE LORENE CECIL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAPLEWOOD RD
HARRISON AR
72601-3099
US

IV. Provider business mailing address

1505 BRENTWOOD DR
HARRISON AR
72601-4707
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-5001
  • Fax:
Mailing address:
  • Phone: 870-577-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number222244
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222244
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: