Healthcare Provider Details

I. General information

NPI: 1669091195
Provider Name (Legal Business Name): JESSICA ROPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 AIRPORT RD
PEARCY AR
71964-9447
US

IV. Provider business mailing address

3131 AIRPORT RD
PEARCY AR
71964-9447
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-8320
  • Fax: 501-701-4061
Mailing address:
  • Phone: 501-315-8320
  • Fax: 501-701-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124400
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: