Healthcare Provider Details

I. General information

NPI: 1477918738
Provider Name (Legal Business Name): JESSICA REAGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/15/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MCQUAY AVE
POCAHONTAS AR
72455
US

IV. Provider business mailing address

PO BOX 83
CORNING AR
72422-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-9949
  • Fax: 870-892-0208
Mailing address:
  • Phone: 870-857-3334
  • Fax: 870-857-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004551
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: