Individual
JACK RYAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3215 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4424
(479) 463-1000
Mailing address
3972 N PARKSIDE DR APT 3, FAYETTEVILLE, AR 72703-7089
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
220260
AR
Other
Enumeration date
03/02/2026
Last updated
03/02/2026
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