Provider Demographics
NPI:1528840113
Name:SWAIN, JILLIAN TYLAR (DNP-FNP)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:TYLAR
Last Name:SWAIN
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:TYLAR
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 RANDOLTH RD
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-9229
Mailing Address - Country:US
Mailing Address - Phone:479-965-5184
Mailing Address - Fax:
Practice Address - Street 1:1902 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6509
Practice Address - Country:US
Practice Address - Phone:479-298-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner