Provider Demographics
NPI:1528319167
Name:AGEE, JAMIE LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:AGEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 HILL PARK CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6251
Mailing Address - Country:US
Mailing Address - Phone:870-333-2721
Mailing Address - Fax:870-333-2720
Practice Address - Street 1:2231 HILL PARK CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6251
Practice Address - Country:US
Practice Address - Phone:870-333-2721
Practice Address - Fax:870-333-2720
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1528319167OtherBLUE CROSS BLUE SHIELD OF AR
AR195198758Medicaid
AR1528319167OtherCIGNA
AR195198758Medicaid