| Doctor Name: | JESSICA REAGAN |
| NPI Number: | 1477918738 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | A004551 |
| Business Practice Address: | 201 Colonial Dr Walnut Ridge, AR - 724761410 |
| Business Phone Number: | 8708865507 |
| Business Fax Number: | 8078865632 |
| Mailing Address: | Po Box 83, CORNING |
| State: | AR |
| Postal Code: | 724220083 |
| Phone Number: | 8708573334 |
| Fax Number: | 8708579934 |
| NPI Enumeration Date: | 12/30/2015 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A004551 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |