Provider Demographics
NPI:1245928258
Name:WITHERS, JIMINA NETTOYIA (RN)
Entity type:Individual
Prefix:
First Name:JIMINA
Middle Name:NETTOYIA
Last Name:WITHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JIMINA
Other - Middle Name:NETTOYIA
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6303 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-2715
Mailing Address - Country:US
Mailing Address - Phone:501-749-0002
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-526-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218475207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease