Healthcare Provider Details

I. General information

NPI: 1124468913
Provider Name (Legal Business Name): STEPHANIE RACHELLE JEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WEST 10TH STREET FREEWAY MEDICAL BUILDING, SUITE 7-500
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

5800 WEST 10TH STREET FREEWAY MEDICAL BUILDING, SUITE 7-500
LITTLE ROCK AR
72204
US

V. Phone/Fax

Practice location:
  • Phone: 501-296-1700
  • Fax: 501-296-1701
Mailing address:
  • Phone: 501-296-1700
  • Fax: 501-296-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: