Provider Demographics
NPI:1265092134
Name:HEISSERER, JENNIFER C (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:HEISSERER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:MATTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4600 MERCY LN STE 240
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3070
Mailing Address - Country:US
Mailing Address - Phone:479-338-4400
Mailing Address - Fax:479-347-3808
Practice Address - Street 1:4600 MERCY LN STE 240
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3070
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:479-347-3808
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner