Individual
MR. JAMIE KEITH PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
6701 HIGHWAY 67 BLDG 70, BENTON, AR 72015-8909
(501) 315-3344
(501) 303-3186
Mailing address
6701 HIGHWAY 67 BLDG 70, BENTON, AR 72015-8909
(501) 315-3344
(501) 303-3186
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
L38028
AR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/29/2007
Last updated
10/12/2009
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