Healthcare Provider Details

I. General information

NPI: 1114384252
Provider Name (Legal Business Name): JESSICA DAILEY HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E MATTHEWS AVE
JONESBORO AR
72401-4348
US

IV. Provider business mailing address

3114 FOX RD
JONESBORO AR
72404-9322
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-3106
  • Fax:
Mailing address:
  • Phone: 870-933-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2718
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: