Healthcare Provider Details

I. General information

NPI: 1508478066
Provider Name (Legal Business Name): JALEESA SHEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 12/29/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 COMMERCIAL CENTER DR STE 2
MARION AR
72364-9616
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-7920
  • Fax: 870-732-7923
Mailing address:
  • Phone: 866-972-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number212808
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: