Healthcare Provider Details

I. General information

NPI: 1639774722
Provider Name (Legal Business Name): AJ'S HEALTH & WELLNESS ENTERPRISES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1400 W 43RD AVE
PINE BLUFF AR
71603-7010
US

IV. Provider business mailing address

1400 W 43RD AVE
PINE BLUFF AR
71603-7010
US

V. Phone/Fax

Practice location:
  • Phone: 870-413-9968
  • Fax: 870-535-0594
Mailing address:
  • Phone: 870-413-9968
  • Fax: 870-535-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY DANIELLE JAMES
Title or Position: CEO/PRESIDENT
Credential: DNP, APRN
Phone: 870-413-9968