Healthcare Provider Details

I. General information

NPI: 1235093113
Provider Name (Legal Business Name): MARIA FERNANDA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 FOX MEADOW LN
JONESBORO AR
72404-9346
US

IV. Provider business mailing address

2808 FOX MEADOW LN
JONESBORO AR
72404-9346
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-4245
  • Fax: 870-931-4457
Mailing address:
  • Phone: 870-932-4245
  • Fax: 870-931-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: