Provider Demographics
NPI:1700409182
Name:DWYER, JESSICA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:DWYER
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 1:17 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2918
Mailing Address - Country:US
Mailing Address - Phone:870-508-5900
Mailing Address - Fax:870-508-5995
Practice Address - Street 1:17 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2918
Practice Address - Country:US
Practice Address - Phone:870-508-5900
Practice Address - Fax:870-508-5995
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily