Provider Demographics
NPI:1861775314
Name:WASHINGTON, JERLENE LAMELLE (APN)
Entity type:Individual
Prefix:
First Name:JERLENE
Middle Name:LAMELLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JERLENE
Other - Middle Name:LAMELLE
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:7500 DOLLARWAY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3082
Mailing Address - Country:US
Mailing Address - Phone:870-247-2305
Mailing Address - Fax:870-247-2330
Practice Address - Street 1:7500 DOLLARWAY RD STE 105
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3082
Practice Address - Country:US
Practice Address - Phone:870-247-2305
Practice Address - Fax:870-247-2330
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03529ANP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health