Individual
DR. JACQUELYN RAE LANGE-HALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2580 E JOYCE BLVD STE 1, FAYETTEVILLE, AR 72703-3924
(479) 305-7201
(949) 577-4833
Mailing address
PO BOX 8936, FAYETTEVILLE, AR 72703-0016
(479) 305-7201
(479) 900-9930
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E-9197
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211861001
—
AR
Enumeration date
04/18/2011
Last updated
10/18/2021
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