Healthcare Provider Details

I. General information

NPI: 1144535113
Provider Name (Legal Business Name): JAMIE SUE MONROE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 W MARKHAM ST
LITTLE ROCK AR
72205-2173
US

IV. Provider business mailing address

20750 KEITH PERSON RD
SILOAM SPRINGS AR
72761-8550
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-9700
  • Fax: 501-227-9727
Mailing address:
  • Phone: 479-208-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR64526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: