Provider Demographics
NPI:1093470213
Name:MAR, JAMIE ELIZABETH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:MAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLCOMBE LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-4223
Mailing Address - Country:US
Mailing Address - Phone:479-657-3746
Mailing Address - Fax:
Practice Address - Street 1:1002 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8610
Practice Address - Country:US
Practice Address - Phone:479-338-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR215173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily