Provider Demographics
NPI:1427240951
Name:VANDETT, JESSICA GAITHER (MSN, APN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GAITHER
Last Name:VANDETT
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MYRA
Other - Last Name:GAITHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, ARNP, FNP-C
Mailing Address - Street 1:9053 HIGHWAY 107
Mailing Address - Street 2:THE CLINIC AT WALMART (OPERATED BY ST. VINCENT)
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2933
Mailing Address - Country:US
Mailing Address - Phone:501-552-6485
Mailing Address - Fax:
Practice Address - Street 1:9053 HIGHWAY 107
Practice Address - Street 2:THE CLINIC AT WALMART (OPERATED BY ST. VINCENT)
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2933
Practice Address - Country:US
Practice Address - Phone:501-552-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265161363LF0000X
ARA03423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily