Provider Demographics
NPI:1245559681
Name:CHURCHILL, JEANNE MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MICHELLE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3624
Mailing Address - Country:US
Mailing Address - Phone:501-327-0110
Mailing Address - Fax:501-327-0141
Practice Address - Street 1:600 CLUB LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3624
Practice Address - Country:US
Practice Address - Phone:501-327-0110
Practice Address - Fax:501-327-0141
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03366 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188595758Medicaid