Active NPI
Jennifer Sue Young, APRN
- Pediatric Nurse Practitioner
- Corning, AR
National Provider Identifier
1003203274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- A004391
- Practice address
- 1300 Creason Rd
Corning, AR 72422-1716 - Phone
- (870) 857-3399
- NPI assigned
- Apr 24, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | A004391 | AR | Primary |
Addresses
Primary practice location
1300 Creason Rd
Corning, AR 72422-1716
Mailing address
PO Box 83
Corning, AR 72422-0083
Phone (870) 857-3334
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209603758 | Medicaid | AR |
Other names 1
- Jennifer Sue Smith
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A004391 | AR | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 1St Choice Healthcare Inc | Past | Accepting new patients |
Interoperability endpoints
- jennifer.smith@1st.eclinicaldirectplus.com
- https://fhir4.healow.com/fhir/r4/FCFIAA/Endpoint/FCFIAA
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Corning, AR
- NPI 1942256508
-
- Federally Qualified Health Center (FQHC)
- Walnut Ridge, AR
- NPI 1598711152
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1003203274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 83",
"city": "CORNING",
"state": "AR",
"postal_code": "724220083",
"telephone_number": "870-857-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 CREASON RD",
"city": "CORNING",
"state": "AR",
"postal_code": "724221716",
"telephone_number": "870-857-3399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JENNIFER",
"middle_name": "SUE",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-24",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AR",
"license": "A004391",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209603758",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "SMITH",
"middle_name": "SUE",
"credential": "APRN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Corning, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.