Individual
JEREMY EDWARD ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 336-8100
Mailing address
5625 WILDFLOWER CT, JONESBORO, AR 72404-8882
(870) 558-9234
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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