NPI 1568818672

Jayvian Johnson

Practitioner Contractor Little Rock, AR

Practice location

Address: 2116 E 11th St, Little Rock, AR 72202-4320
Phone: (501) 425-8174
Mailing address: PO Box 166415, Little Rock, AR 72216-6415

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 46-0763339 (AR)

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Registry record

NPI: 1568818672
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 May 2016
Record last updated: 6 May 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.