Provider Demographics
NPI:1598570426
Name:VASQUEZ, JESSICA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4164
Mailing Address - Country:US
Mailing Address - Phone:479-782-0244
Mailing Address - Fax:479-226-3148
Practice Address - Street 1:2420 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4164
Practice Address - Country:US
Practice Address - Phone:479-782-0244
Practice Address - Fax:479-226-3148
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR230734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty