Provider Demographics
NPI:1790142974
Name:JAKES, ARIEL LANICE (FNP)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:LANICE
Last Name:JAKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2650
Mailing Address - Country:US
Mailing Address - Phone:870-541-7235
Mailing Address - Fax:870-541-4297
Practice Address - Street 1:1609 W 40TH AVE STE 312
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6366
Practice Address - Country:US
Practice Address - Phone:870-541-7201
Practice Address - Fax:870-541-7202
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily