Healthcare Provider Details

I. General information

NPI: 1033099254
Provider Name (Legal Business Name): HAIR JENETIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2787 HWY 77 S STE 6
MARION AR
72364-2383
US

IV. Provider business mailing address

2787 HWY 77 S STE 6
MARION AR
72364-2383
US

V. Phone/Fax

Practice location:
  • Phone: 901-481-5375
  • Fax:
Mailing address:
  • Phone: 901-481-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER THOMAS
Title or Position: CEO
Credential: SPECIALIST
Phone: 901-481-5375