Individual
MRS. JESSICA MARIE BRANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3000 MEDICAL CENTER PKWY, BENTONVILLE, AR 72712-3217
(479) 553-1000
Mailing address
11588 TONY MOUNTAIN RD, FAYETTEVILLE, AR 72701-9357
(573) 683-1280
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
2009007465
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
C02903
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180228758
—
AR
01
—
431560263
TRICARE WEST
—
Enumeration date
10/13/2009
Last updated
04/08/2021
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