Provider Demographics
NPI:1114571072
Name:STUCKEY, JESSIE MERANDA (MNSC, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:MERANDA
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:MNSC, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 HURON LN STE 5
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2491
Mailing Address - Country:US
Mailing Address - Phone:501-904-4762
Mailing Address - Fax:501-708-2185
Practice Address - Street 1:11501 HURON LN STE 5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2491
Practice Address - Country:US
Practice Address - Phone:501-904-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121696363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health