Provider Demographics
NPI:1134257967
Name:EARLY, JACQUOLYN JO (APRN)
Entity type:Individual
Prefix:
First Name:JACQUOLYN
Middle Name:JO
Last Name:EARLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:EARLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:530 ATKINS BLVD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2198
Mailing Address - Country:US
Mailing Address - Phone:870-295-5225
Mailing Address - Fax:870-295-4070
Practice Address - Street 1:530 ATKINS BLVD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2198
Practice Address - Country:US
Practice Address - Phone:870-295-5225
Practice Address - Fax:870-295-4070
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y160Medicare ID - Type Unspecified
ARQ34309Medicare UPIN