MEDICARE: JASIE RENAE OGLESBY

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	225200000X	Physical Therapy Assistant	4909	AR

General Provider Information

NPI Number	:	1871355180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASIE RENAE OGLESBY

Provider Business Mailing Address
First Line	:	17706 INTERSTATE 30 N STE 3
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-2930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17706 INTERSTATE 30 N STE 3
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-2930
Country	:	US
Telephone Number	:	501-315-4414
Fax Number	:

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	12/10/2025

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Directions to “ JASIE RENAE OGLESBY ” Practice Location

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