Healthcare Provider Details

I. General information

NPI: 1679496384
Provider Name (Legal Business Name): JESSICA LEEANNE JENNIFER THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11402 W MARKHAM ST
LITTLE ROCK AR
72211-2806
US

IV. Provider business mailing address

1221 CHERRY LN
BENTON AR
72015-4607
US

V. Phone/Fax

Practice location:
  • Phone: 501-482-3389
  • Fax:
Mailing address:
  • Phone: 430-200-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number238906
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: