Provider Demographics
NPI:1487295572
Name:ISAACS, JACQUELYN RENEE
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RENEE
Last Name:ISAACS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2550
Mailing Address - Country:US
Mailing Address - Phone:479-221-9922
Mailing Address - Fax:479-221-9988
Practice Address - Street 1:1000 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2550
Practice Address - Country:US
Practice Address - Phone:479-221-9922
Practice Address - Fax:479-221-9988
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner