Provider Demographics
NPI:1821836479
Name:ROSE, JERROD DARNELL (RN)
Entity type:Individual
Prefix:
First Name:JERROD
Middle Name:DARNELL
Last Name:ROSE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-1603
Mailing Address - Country:US
Mailing Address - Phone:870-549-7713
Mailing Address - Fax:
Practice Address - Street 1:1408 LINKS DR APT 10
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7301
Practice Address - Country:US
Practice Address - Phone:870-549-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR228469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse