Provider Demographics
NPI:1972130078
Name:BROWN, JACQUELINE LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LEIGH
Last Name:BROWN
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:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:COLT
Mailing Address - State:AR
Mailing Address - Zip Code:72326-0235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5082 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7675
Practice Address - Country:US
Practice Address - Phone:870-261-9149
Practice Address - Fax:870-261-9988
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR253702758Medicaid