Healthcare Provider Details

I. General information

NPI: 1770075558
Provider Name (Legal Business Name): JADIE ELIZABETH DANIEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15111 HIGHWAY 165
SCOTT AR
72142-9596
US

IV. Provider business mailing address

1920 FALLS BLVD N
WYNNE AR
72396-4027
US

V. Phone/Fax

Practice location:
  • Phone: 501-229-8200
  • Fax: 870-587-0799
Mailing address:
  • Phone: 870-587-0800
  • Fax: 870-587-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005548
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: