Provider Demographics
NPI:1699519769
Name:WAINWRIGHT, JESSICA (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BENTLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5809
Mailing Address - Country:US
Mailing Address - Phone:574-344-1717
Mailing Address - Fax:
Practice Address - Street 1:1061 FRONT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4305
Practice Address - Country:US
Practice Address - Phone:501-300-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health