Healthcare Provider Details

I. General information

NPI: 1861216137
Provider Name (Legal Business Name): JAYLA FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 STRAIT ST
MORRILTON AR
72110-1837
US

IV. Provider business mailing address

109 STRAIT ST
MORRILTON AR
72110-1837
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-4484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number126146
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: