Healthcare Provider Details

I. General information

NPI: 1255241972
Provider Name (Legal Business Name): JENNIFER BRACKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

701 OLD BRIDGER RD
JONESBORO AR
72401-8458
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number239486
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: