Healthcare Provider Details

I. General information

NPI: 1043936792
Provider Name (Legal Business Name): ANDREA JONES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 MERRILL DR STE D240
LITTLE ROCK AR
72211-1821
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-3700
  • Fax: 501-312-0694
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR085234
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: