Healthcare Provider Details

I. General information

NPI: 1144108036
Provider Name (Legal Business Name): JAREN JURIAN HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2708 S RIFE MEDICAL LN STE 300
ROGERS AR
72758-1457
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3030
  • Fax: 479-338-3079
Mailing address:
  • Phone: 479-338-3030
  • Fax: 479-338-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1445
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: