Healthcare Provider Details

I. General information

NPI: 1114308707
Provider Name (Legal Business Name): JESSICA JOANN JOHNSON FNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA JOANN STEVENS

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6924 GEYER SPRINGS RD
LITTLE ROCK AR
72209-2728
US

IV. Provider business mailing address

6924 GEYER SPRINGS RD
LITTLE ROCK AR
72209-2728
US

V. Phone/Fax

Practice location:
  • Phone: 501-562-1463
  • Fax: 501-803-9991
Mailing address:
  • Phone: 501-562-1463
  • Fax: 501-803-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004367
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: