Healthcare Provider Details

I. General information

NPI: 1861775314
Provider Name (Legal Business Name): JERLENE LAMELLE WASHINGTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JERLENE LAMELLE BUTCHER APN

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 DOLLARWAY RD STE 105
WHITE HALL AR
71602-3082
US

IV. Provider business mailing address

7500 DOLLARWAY RD STE 105
WHITE HALL AR
71602-3082
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-2305
  • Fax: 870-247-2330
Mailing address:
  • Phone: 870-247-2305
  • Fax: 870-247-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA03529ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: