Provider Demographics
NPI:1104885581
Name:NUNLEY, JONATHAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:NUNLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0507
Mailing Address - Country:US
Mailing Address - Phone:913-647-4100
Mailing Address - Fax:913-647-4120
Practice Address - Street 1:2710 S RIFE MEDICAL LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-8000
Practice Address - Fax:479-338-3056
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4615207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200003690AMedicaid
ARP00288003OtherRR
AR5N453OtherBCBS ARKANSAS
MO1104885581Medicaid
AR159158001Medicaid