Healthcare Provider Details

I. General information

NPI: 1144708058
Provider Name (Legal Business Name): JORDAN SCOTT VALLIERES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 S HOLLY ST
SILOAM SPRINGS AR
72761-3018
US

IV. Provider business mailing address

614 E EMMA AVE STE 300
SPRINGDALE AR
72764-4469
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-3141
  • Fax:
Mailing address:
  • Phone: 479-751-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223337
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: