Healthcare Provider Details

I. General information

NPI: 1750386553
Provider Name (Legal Business Name): LARRY BRYAN JENNINGS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/16/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 HIGHWAY 65 N
MARSHALL AR
72650-1060
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-5733
  • Fax: 870-448-3392
Mailing address:
  • Phone: 870-448-5733
  • Fax: 870-448-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2480
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR2480
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: