Individual
JENNIE P MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
130 SPRING ST, SPRINGDALE, AR 72764-4567
(479) 751-5704
(479) 750-7050
Mailing address
257 PINE MEADOW DR, FARMINGTON, AR 72730-8624
(479) 267-0268
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
A0810076
AR
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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