Healthcare Provider Details

I. General information

NPI: 1629966965
Provider Name (Legal Business Name): ALICIA K JAGODZINSKI DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SHACKLEFORD DR
LITTLE ROCK AR
72211-2858
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 500-501-5001
  • Fax:
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number120993
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: