Provider Demographics
NPI:1528571148
Name:AUD, JAMIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:AUD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W HOLLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-9221
Mailing Address - Country:US
Mailing Address - Phone:870-850-8055
Mailing Address - Fax:870-850-8056
Practice Address - Street 1:1600 W HOLLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-9221
Practice Address - Country:US
Practice Address - Phone:870-850-8055
Practice Address - Fax:870-850-8056
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily