Provider Demographics
NPI:1710462056
Name:HALE, JAMIE (APRN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4704
Mailing Address - Country:US
Mailing Address - Phone:870-425-6398
Mailing Address - Fax:870-425-6402
Practice Address - Street 1:130 E 9TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4704
Practice Address - Country:US
Practice Address - Phone:870-425-6398
Practice Address - Fax:870-425-6402
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA005926OtherCNP LICENSE
ARR102783OtherRN LICENSE