Provider Demographics
NPI:1396599726
Name:LAGRONE, JESSICA (CD, CCE, MAT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LAGRONE
Suffix:
Gender:F
Credentials:CD, CCE, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 STONEHENGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-3860
Mailing Address - Country:US
Mailing Address - Phone:479-463-9355
Mailing Address - Fax:
Practice Address - Street 1:3847 STONEHENGE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-3860
Practice Address - Country:US
Practice Address - Phone:479-463-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14734374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula