Healthcare Provider Details

I. General information

NPI: 1700451069
Provider Name (Legal Business Name): JESSICA WELLS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA POWERS

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W TYLER AVE
WEST MEMPHIS AR
72301-4223
US

IV. Provider business mailing address

1978 BAKERSFIELD TRCE
NESBIT MS
38651-6024
US

V. Phone/Fax

Practice location:
  • Phone: 662-292-1595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number902290
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number219358
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number30586
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: