1356068472 NPI number — SARAH ANN JENNINGS LPN

Table of content: SARAH ANN JENNINGS LPN (NPI 1356068472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356068472 NPI number — SARAH ANN JENNINGS LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
SARAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356068472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 PEARSON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72015-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-331-5422
Provider Business Mailing Address Fax Number:
501-778-0450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 PEARSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72015-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-315-4224
Provider Business Practice Location Address Fax Number:
501-778-0450
Provider Enumeration Date:
10/20/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  L053708 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)