Provider Demographics
NPI:1184861767
Name:JLW ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JLW ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-562-2505
Mailing Address - Street 1:1417 CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2621
Mailing Address - Country:US
Mailing Address - Phone:870-562-2505
Mailing Address - Fax:
Practice Address - Street 1:600 LELIA
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-4035
Practice Address - Country:US
Practice Address - Phone:870-234-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01537363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145671758Medicaid
5W576OtherBLUE CROSS BLUE SHIELD
AR145671758Medicaid