Individual
JASON PAUL PETTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16 WHISPERING OAK DR, MABELVALE, AR 72103-2065
(501) 400-5306
Mailing address
16 WHISPERING OAK DR, MABELVALE, AR 72103-2065
(501) 400-5306
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
942803758
AR
332U00000X
Home Delivered Meals
—
AR
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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