Healthcare Provider Details

I. General information

NPI: 1871239236
Provider Name (Legal Business Name): JENNIFER MARIE CAMPBELL MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE WALKER

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

IV. Provider business mailing address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

V. Phone/Fax

Practice location:
  • Phone: 501-906-3000
  • Fax:
Mailing address:
  • Phone: 501-906-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number19387
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: