Provider Demographics
NPI:1023814621
Name:IVY, MARJORIE
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8345
Mailing Address - Country:US
Mailing Address - Phone:870-273-5332
Mailing Address - Fax:
Practice Address - Street 1:2912 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8345
Practice Address - Country:US
Practice Address - Phone:870-273-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health