Provider Demographics
NPI:1699785899
Name:SPEARS, JENNIE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:MARIE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0550
Mailing Address - Country:US
Mailing Address - Phone:479-463-7775
Mailing Address - Fax:479-463-7187
Practice Address - Street 1:146A PASSION PLAY RD
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632
Practice Address - Country:US
Practice Address - Phone:479-253-9746
Practice Address - Fax:479-253-2464
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4579363L00000X
ARA005272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748699Medicaid
AZZ90158Medicare UPIN