MEDICARE: JENNIE ANDERSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A003977	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205250693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE ANDERSON APRN

Provider Business Mailing Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S STE 201
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-6678
Country	:	US
Telephone Number	:	501-745-8007
Fax Number	:	501-745-8220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	05/28/2021

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Directions to “ JENNIE ANDERSON APRN” Practice Location

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