Provider Demographics
NPI:1124584503
Name:HOUSER, JESSICA (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOUSER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKESBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71846-9629
Mailing Address - Country:US
Mailing Address - Phone:870-784-2179
Mailing Address - Fax:
Practice Address - Street 1:101 W MAIN
Practice Address - Street 2:
Practice Address - City:LOCKESBURG
Practice Address - State:AR
Practice Address - Zip Code:71846-9621
Practice Address - Country:US
Practice Address - Phone:870-289-0001
Practice Address - Fax:870-289-0002
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR235954758Medicaid