Healthcare Provider Details

I. General information

NPI: 1336363597
Provider Name (Legal Business Name): JESSICA JOHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LILE DR
LITTLE ROCK AR
72205-6217
US

IV. Provider business mailing address

10001 LILE DR
LITTLE ROCK AR
72205-6217
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-8000
  • Fax: 501-604-8758
Mailing address:
  • Phone: 501-227-8000
  • Fax: 501-604-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE225
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: