Provider Demographics
NPI:1922157924
Name:CRAIG, JENNIFER J (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 E JOYCE BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5011
Mailing Address - Country:US
Mailing Address - Phone:479-442-9900
Mailing Address - Fax:479-442-9903
Practice Address - Street 1:2907 E JOYCE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5011
Practice Address - Country:US
Practice Address - Phone:479-442-9900
Practice Address - Fax:479-442-9903
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200106030AMedicaid
AR164359001Medicaid
OK200106030AMedicaid