Provider Demographics
NPI:1033653282
Name:WINSTON, JESSICA RENEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:RENEE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-0100
Mailing Address - Country:US
Mailing Address - Phone:870-942-3000
Mailing Address - Fax:870-942-3005
Practice Address - Street 1:506 LITTLE CREEK CUT OFF RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7798
Practice Address - Country:US
Practice Address - Phone:870-942-3000
Practice Address - Fax:870-942-3005
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant