JENELLE WALLIS (NPI# 1386279032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386279032 |
| Entity Type | Individual |
| Full Name | JENELLE WALLIS |
| Credential | APRN |
| Practice Address |
10100 Kanis Rd Little Rock AR 72205-6202 |
| Practice Telephone | 5012556000 |
| Practice Fax Number | 5012556400 |
| Mailing Telephone | 5012556000 |
| Mailing Fax Number | 5012556400 |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-03-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
124001 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
10100 KANIS RD |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72205-6202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073576625 | Yalcin Hacioglu | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2006-04-06 |
| 1831721059 | Keely Sparks | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2020-02-05 |
| 1073078648 | Ashley Allison Long | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2019-02-07 |
| 1144771296 | Kayla Beth Ingram-smith | Clinical Nurse Specialist | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2016-10-24 |
| 1093174716 | Callie Reynolds | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2016-02-23 |
| 1619216496 | Sara Ann Thompson | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2013-02-13 |
| 1811236789 | Leah Brazil | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2013-02-12 |
| 1023381738 | St. Vincent Infirmary Medical Center | Clinic/Center | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2012-02-13 |
| 1679875017 | Abdel Rahman A Al Emam | Internal Medicine | 10100 Kanis Rd, Little Rock, AR 72205 | 2010-11-17 |
| 1013151273 | Angela Eileen Cartwright | Nurse Practitioner | 10100 Kanis Rd, Little Rock, AR 72205-6202 | 2009-04-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932719465 | Darleisha Renee Stigall | Behavior Technician | 1210 Aldersdate Rd, Little Rock, AR 72205 | 2020-08-10 |
| 1316563638 | Unknown Amisha | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot #634, University of Arkansas, Little Rock, AR 72205 | 2020-06-23 |
| 1225667272 | Ann-marie Frances Hayre | Student in an Organized Health Care Education/Training Program | 4310 West Markham, Slot 589, Little Rock, AR 72205 | 2020-04-02 |
| 1952930075 | Alexandria Leigh Smith | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot 531, Little Rock, AR 72205 | 2020-04-02 |
| 1093353922 | Phil Fagala | Pharmacist | 614 North Beechwood, Little Rock, AR 72205 | 2019-12-10 |
| 1295391688 | Home To Community Living, Inc | Physical Therapist | 10201 W Markham Street Pulaski, Little Rock, AR 72205 | 2019-05-12 |
| 1669933693 | Sandy Louise Webb | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 530, Little Rock, AR 72205 | 2019-03-31 |
| 1457812828 | Vincent Battafarano | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 602, Little Rock, AR 72205 | 2019-03-28 |
| 1063978922 | Franks Pediatric Occupational Therapy LLC | Occupational Therapist | 5516 C St, Little Rock, AR 72205 | 2019-02-15 |
| 1497210199 | Integrative Counseling Center LLC | Counselor | 10515 W Markham St Ste D3, Little Rock, AR 72205 | 2019-02-06 |
| Find all providers in zip 72205 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528691912 | Rachel Wetherington | Nurse Practitioner | 9501 Baptist Health Dr Ste 500, Little Rock, AR 72205-6225 | 2020-02-13 |
| 1811492242 | Megan Ashley Thomas | Nurse Practitioner | 816 N Polk St, Little Rock, AR 72205-3448 | 2018-03-27 |
| 1669972022 | Kristie Stringer | Nurse Practitioner | 11001 Executive Center Dr Ste 200, Little Rock, AR 72211-4393 | 2018-02-12 |
| 1265892186 | Maeghan E Arnold | Nurse Practitioner | 8901 Carti Way Ste 302, Little Rock, AR 72205-6523 | 2016-03-04 |
| 1891103073 | Deborah Evans | Nurse Practitioner | 5 Saint Vincent Cir Ste 500, Little Rock, AR 72205-5412 | 2014-07-31 |
| 1356683890 | Sarah Y. Floyd | Nurse Practitioner | 19 Hatfield Dr, Little Rock, AR 72209-6127 | 2013-03-22 |
| 1265710958 | Dana Lynn Phillips | Nurse Practitioner | 4301 W. Markham Slot 783, Little Rock, AR 72205-7101 | 2011-07-28 |
| 1609050087 | Nicholas Jay Fazio | Nurse Practitioner | 6119 Midtown Ave Ste 202, Little Rock, AR 72205 | 2007-12-20 |
| 1053593509 | Audra Page Arant | Nurse Practitioner | 4301 W Markham St # 602a, Little Rock, AR 72205-7101 | 2007-11-27 |
| 1366537466 | Melody A Walls | Nurse Practitioner | 9500 Kanis Rd Ste 101, Little Rock, AR 72205-6358 | 2006-10-04 |
| Find all providers in LITTLE ROCK | ||||
| City | LITTLE ROCK |
| Zip Code | 72205 |
Please comment or provide details below to improve the information on JENELLE WALLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.