Healthcare Provider Details

I. General information

NPI: 1366485393
Provider Name (Legal Business Name): JANE MIERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E KIEHL AVE
SHERWOOD AR
72120-3040
US

IV. Provider business mailing address

1308 E KIEHL AVE
SHERWOOD AR
72120-3040
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-0703
  • Fax: 501-834-6249
Mailing address:
  • Phone: 501-835-0703
  • Fax: 501-834-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7866
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: