Basic Information
| Provider Information | |||||||||
| NPI: | 1417456443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | RAINIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018895543 | ||||||||
| FaxNumber: | 5018895546 | ||||||||
| Practice Location | |||||||||
| Address1: | 518 N FOURCHE AVE | ||||||||
| Address2: | |||||||||
| City: | PERRYVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721269701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018895543 | ||||||||
| FaxNumber: | 5018895546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A005478 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.