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General NPI Number Information
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NPI Number | 1184861767
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Entity Type | Organization
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Legal Business Name | JLW ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 600 LELIA
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City | MAGNOLIA
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State | AR
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Zip | 71753-4035
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Country | US
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Telephone | 870-234-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 CHESTNUT
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City | MAGNOLIA
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State | AR
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Zip | 71753-2621
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Country | US
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Telephone | 870-562-2505
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Fax |
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Authorized Official
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Title or Position | GERIATRIC NURSE PRACTITIONER
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Name | MISS JESSICA JANE WESTFALL
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Credential | APN
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Telephone | 870-562-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | A01537
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License Number State | AR
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