Provider Demographics
NPI:1881150563
Name:NEWCOMB, JESSICA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:NEWCOMB
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 1:4052 N ABINGTON CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5047
Mailing Address - Country:US
Mailing Address - Phone:479-856-2601
Mailing Address - Fax:
Practice Address - Street 1:4301 GREATHOUSE SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:AR
Practice Address - Zip Code:72741
Practice Address - Country:US
Practice Address - Phone:479-684-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006137363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics