Healthcare Provider Details

I. General information

NPI: 1316672512
Provider Name (Legal Business Name): JENNIFER HAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 01/30/2024
Certification Date: 01/26/2024
Deactivation Date: 07/21/2022
Reactivation Date: 08/10/2022

III. Provider practice location address

PT ELITE MENS HEALTH 2203 E NETTLETON AVE SUITE A
JONESBORO AR
72401
US

IV. Provider business mailing address

800 S CHURCH ST STE 400
JONESBORO AR
72401-4112
US

V. Phone/Fax

Practice location:
  • Phone: 870-203-9889
  • Fax:
Mailing address:
  • Phone: 870-935-6012
  • Fax: 870-934-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221342
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221342
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: