Healthcare Provider Details

I. General information

NPI: 1336793611
Provider Name (Legal Business Name): JORDAN BROOKE FLETCHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 INDUSTRIAL PARK DR
TRUMANN AR
72472-9602
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3666
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number121621
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: