Individual
JEREMY EDWARD ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 SW BROAD ST, HOXIE, AR 72433-2419
(870) 558-9234
Mailing address
5625 WILDFLOWER CT, JONESBORO, AR 72404-8882
(870) 558-9234
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
06/17/2026
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