Provider Demographics
NPI:1366990343
Name:PRICE, JENNIFER LYNN (DNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:PRICE
Suffix:
Gender:F
Credentials:DNP
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 927
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-0927
Mailing Address - Country:US
Mailing Address - Phone:501-944-4155
Mailing Address - Fax:501-286-6046
Practice Address - Street 1:2796 S 2ND ST STE E
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7043
Practice Address - Country:US
Practice Address - Phone:501-443-3818
Practice Address - Fax:501-521-1001
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR004876363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217143758Medicaid
AR534966YJG2Medicare PIN