Provider Demographics
NPI:1164734174
Name:AMES, JENNIFER NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:AMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7512
Mailing Address - Country:US
Mailing Address - Phone:501-847-0082
Mailing Address - Fax:501-847-6680
Practice Address - Street 1:507 W COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7512
Practice Address - Country:US
Practice Address - Phone:501-847-0082
Practice Address - Fax:501-847-6680
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7327207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine