Healthcare Provider Details

I. General information

NPI: 1649183542
Provider Name (Legal Business Name): MARTI JO WHITEHEAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 KERSEY LN
JONESBORO AR
72404-8804
US

IV. Provider business mailing address

5603 KERSEY LN
JONESBORO AR
72404-8804
US

V. Phone/Fax

Practice location:
  • Phone: 870-931-2668
  • Fax: 870-935-6203
Mailing address:
  • Phone: 870-935-6200
  • Fax: 870-935-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR063415
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: