Healthcare Provider Details

I. General information

NPI: 1528319167
Provider Name (Legal Business Name): JAMIE LEIGH AGEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2012
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 HILL PARK CV
JONESBORO AR
72401-6251
US

IV. Provider business mailing address

2231 HILL PARK CV
JONESBORO AR
72401-6251
US

V. Phone/Fax

Practice location:
  • Phone: 870-333-2721
  • Fax: 870-333-2720
Mailing address:
  • Phone: 870-333-2721
  • Fax: 870-333-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003773
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: