Provider Demographics
NPI:1437125903
Name:JAGGERS, LISA GAYE (REGNURSEPRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
Last Name:JAGGERS
Suffix:
Gender:F
Credentials:REGNURSEPRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5806
Mailing Address - Country:US
Mailing Address - Phone:870-236-2600
Mailing Address - Fax:870-236-3314
Practice Address - Street 1:1910 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5806
Practice Address - Country:US
Practice Address - Phone:870-236-2600
Practice Address - Fax:870-236-3314
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner