Provider Demographics
NPI:1831314939
Name:ALEXANDER, JARITA MICKEL (CIS CLERICAL)
Entity Type:Individual
Prefix:
First Name:JARITA
Middle Name:MICKEL
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CIS CLERICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:2707 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7213
Practice Address - Country:US
Practice Address - Phone:870-972-4939
Practice Address - Fax:870-972-4911
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN143801797023747A0650X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered376J00000XNursing Service Related ProvidersHomemaker