Provider Demographics
NPI:1295113272
Name:HEWLETT, JILLIAN LORRAINE (APRN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LORRAINE
Last Name:HEWLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LORRAINE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3232 N NORTHHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4005
Mailing Address - Country:US
Mailing Address - Phone:479-458-7170
Mailing Address - Fax:479-587-1366
Practice Address - Street 1:808 S 52ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8602
Practice Address - Country:US
Practice Address - Phone:479-587-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004433363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210063758Medicaid
OK200890260AMedicaid