Healthcare Provider Details

I. General information

NPI: 1760833123
Provider Name (Legal Business Name): JONATHAN P VECCHIARELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 MEDICAL BLVD
JONESBORO AR
72405-8104
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3625
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberE-16191
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: