Individual
JASMIN ANN LEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2010 ACTIVE WAY, BENTON, AR 72019-7566
(501) 315-0984
(501) 847-1405
Mailing address
PO BOX 3250, BENTON, AR 72018-3250
(501) 315-0984
(501) 847-1405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-349
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA349
LICENSE
AR
Enumeration date
09/15/2008
Last updated
08/03/2012
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