Individual
LORETTA LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1835 GRANT AVE, JONESBORO, AR 72401-6155
(870) 974-9114
Mailing address
1835 GRANT AVE, JONESBORO, AR 72401-6155
(870) 974-9114
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTA213
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138317721
—
AR
Enumeration date
06/06/2006
Last updated
03/21/2024
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