=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528840113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILLIAN TYLAR SWAIN DNP-FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2023
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 S WALDRON RD
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72903-2574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-755-6900
-----------------------------------------------------
Fax | 479-755-6903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 497
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72006-0497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 226174
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------