Provider Demographics
NPI:1124343074
Name:MONICAL, JAYNA J (FNP-BC)
Entity type:Individual
Prefix:
First Name:JAYNA
Middle Name:J
Last Name:MONICAL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-1225
Mailing Address - Country:US
Mailing Address - Phone:479-795-1301
Mailing Address - Fax:479-795-1304
Practice Address - Street 1:1225 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-1225
Practice Address - Country:US
Practice Address - Phone:479-795-1301
Practice Address - Fax:479-795-1304
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009034363LF0000X
AR222403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1124343074Medicaid
KS200641220AMedicaid
KS200641220AMedicaid