Provider Demographics
NPI:1588993810
Name:STRACK, JESSICA R (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:STRACK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SPRINGHILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2949
Mailing Address - Country:US
Mailing Address - Phone:501-955-5589
Mailing Address - Fax:501-955-5960
Practice Address - Street 1:3500 SPRINGHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2949
Practice Address - Country:US
Practice Address - Phone:501-955-5589
Practice Address - Fax:501-955-5960
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant