Healthcare Provider Details

I. General information

NPI: 1285547786
Provider Name (Legal Business Name): JILLIAN ALEXIS ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E MATTHEWS AVE STE A
JONESBORO AR
72401-4346
US

IV. Provider business mailing address

109 S HOLT AVE
TUCKERMAN AR
72473-9007
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-0424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number213779
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: