Healthcare Provider Details

I. General information

NPI: 1801123922
Provider Name (Legal Business Name): JESSICA MICHELLE THOREEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MICHELLE ROWE

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

5224 75TH ST STE D
LUBBOCK TX
79424-2525
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3000
  • Fax:
Mailing address:
  • Phone: 806-712-1096
  • Fax: 806-771-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number081302-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number232406
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number081302-23
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166285-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: