Healthcare Provider Details

I. General information

NPI: 1811704885
Provider Name (Legal Business Name): ROXANNA JENNINGS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-292-3950
  • Fax:
Mailing address:
  • Phone: 870-735-3842
  • Fax: 360-462-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38466
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908046
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231403
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: