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General NPI Number Information
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NPI Number | 1598570426
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Entity Type | Individual
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Provider Name | JESSICA RENEE VASQUEZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 2420 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4164
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Country | US
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Telephone | 479-782-0244
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Fax | 479-226-3148
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Provider Business Mailing Address
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Address Line | 2420 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4164
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Country | US
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Telephone | 479-782-0244
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Fax | 479-226-3148
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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 | 230734
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License Number State | AR
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