Provider Demographics
NPI:1174902795
Name:TURNER, JAIME (PA-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2807
Mailing Address - Country:US
Mailing Address - Phone:479-521-3363
Mailing Address - Fax:479-444-9722
Practice Address - Street 1:2100 N GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2807
Practice Address - Country:US
Practice Address - Phone:479-521-3363
Practice Address - Fax:479-444-9722
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209961795Medicaid
AR209961795Medicaid