Healthcare Provider Details

I. General information

NPI: 1376405506
Provider Name (Legal Business Name): JIANNE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/05/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 WESTWOOD AVE
LITTLE ROCK AR
72204-8264
US

IV. Provider business mailing address

8711 WESTWOOD AVE
LITTLE ROCK AR
72204-8264
US

V. Phone/Fax

Practice location:
  • Phone: 870-592-1782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: