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General NPI Number Information
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NPI Number | 1447804661
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Entity Type | Individual
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Provider Name | JENIFER JOY LOAR APRN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 10201 KANIS RD
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6203
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Country | US
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Telephone | 501-227-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 435 BIRD DOG RD
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City | WARD
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State | AR
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Zip | 72176-7903
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Country | US
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Telephone | 501-259-8072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F06190699
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 120422
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License Number State | AR
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