Provider Demographics
NPI:1689606261
Name:MOBLEY, JESSICA P (APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:MOBLEY
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 1:1906 W HILLSBORO ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6806
Mailing Address - Country:US
Mailing Address - Phone:870-639-6465
Mailing Address - Fax:870-639-6470
Practice Address - Street 1:1906 W HILLSBORO ST STE B
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6806
Practice Address - Country:US
Practice Address - Phone:870-639-6465
Practice Address - Fax:870-639-6470
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001882363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y467OtherMEDICARE
AR281240758Medicaid
ARA001882OtherLICENSE
AR1X1863OtherMEDICARE