Provider Demographics
NPI:1225520356
Name:VINSON, JADE LEIGH
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LEIGH
Last Name:VINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MEDICAL CENTER PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3212
Mailing Address - Country:US
Mailing Address - Phone:479-715-4262
Mailing Address - Fax:866-817-7601
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 110
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3212
Practice Address - Country:US
Practice Address - Phone:479-715-4262
Practice Address - Fax:866-817-7601
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR095301163WC0200X
ARA005815363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine