Healthcare Provider Details

I. General information

NPI: 1164143772
Provider Name (Legal Business Name): ASHLEY JEFFREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

6233 SADDLE HILL DR
ALEXANDER AR
72002-1897
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax:
Mailing address:
  • Phone: 501-349-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR096881
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number232231
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: