Provider Demographics
NPI:1841972361
Name:MARSHALL, JENNIFER IDA (PMHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IDA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WESTFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-6942
Mailing Address - Country:US
Mailing Address - Phone:501-765-0213
Mailing Address - Fax:
Practice Address - Street 1:1516 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5065
Practice Address - Country:US
Practice Address - Phone:501-374-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2022094754363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health