Provider Demographics
NPI:1497922868
Name:LOVE-RYAN, JACQUELINE REGINA
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:REGINA
Last Name:LOVE-RYAN
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 1:620 S LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4859
Mailing Address - Country:US
Mailing Address - Phone:870-534-4900
Mailing Address - Fax:870-534-4900
Practice Address - Street 1:620 S LAUREL
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4859
Practice Address - Country:US
Practice Address - Phone:870-534-4900
Practice Address - Fax:870-534-4900
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR21955163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health