Provider Demographics
NPI:1124468913
Name:JEZ, STEPHANIE RACHELLE (MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RACHELLE
Last Name:JEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 WEST 10TH STREET
Mailing Address - Street 2:FREEWAY MEDICAL BUILDING, SUITE 7-500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-296-1700
Mailing Address - Fax:501-296-1701
Practice Address - Street 1:5800 WEST 10TH STREET
Practice Address - Street 2:FREEWAY MEDICAL BUILDING, SUITE 7-500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-296-1700
Practice Address - Fax:501-296-1701
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS