Healthcare Provider Details

I. General information

NPI: 1114081213
Provider Name (Legal Business Name): DEBRA KAY JENNINGS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205-7100
US

IV. Provider business mailing address

13 STATESBORO CV
CABOT AR
72023-3959
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax:
Mailing address:
  • Phone: 501-686-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR27093
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: