Healthcare Provider Details

I. General information

NPI: 1659493807
Provider Name (Legal Business Name): JENNIFER C DUNAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER COOK

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 N RODNEY PARHAM RD
LITTLE ROCK AR
72227-6212
US

IV. Provider business mailing address

47 SUMMIT RIDGE DR
LITTLE ROCK AR
72211-3072
US

V. Phone/Fax

Practice location:
  • Phone: 501-228-3868
  • Fax: 501-228-3892
Mailing address:
  • Phone: 501-219-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2341
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: