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General NPI Number Information
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NPI Number | 1639725187
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Entity Type | Individual
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Provider Name | JESSICA POLARIS
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 7600 S UNIVERSITY AVE STE 10
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3733
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Country | US
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Telephone | 501-251-9607
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 REVEILLE CIR
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City | JACKSONVILLE
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State | AR
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Zip | 72076-9190
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Country | US
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Telephone | 501-218-6294
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | AR
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