Provider Demographics
NPI:1659766939
Name:BLANEY, JENNIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 BATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8912
Mailing Address - Country:US
Mailing Address - Phone:870-262-2800
Mailing Address - Fax:870-262-2815
Practice Address - Street 1:1217 BATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AR
Practice Address - Zip Code:72501-8912
Practice Address - Country:US
Practice Address - Phone:870-262-2800
Practice Address - Fax:870-262-2815
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily