Healthcare Provider Details

I. General information

NPI: 1982115218
Provider Name (Legal Business Name): TABITHA JAGGERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 W WALSH LN STE 204
ROGERS AR
72758-9001
US

IV. Provider business mailing address

PO BOX 2860
BENTON AR
72018-2860
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-3337
  • Fax: 479-800-1122
Mailing address:
  • Phone: 501-315-4008
  • Fax: 501-315-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA738
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: