Active NPI
Jade Leigh Vinson
- Primary Care Nurse Practitioner
- Bentonville, AR
National Provider Identifier
1225520356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- A005815
- Practice address
- 2900 Medical Center Pkwy Ste 110
Bentonville, AR 72712-3212 - Phone
- (479) 715-4262
- Fax
- (866) 817-7601
- NPI assigned
- Jun 4, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | R095301 | AR | |
| Primary Care Nurse Practitioner | 363LP2300X | A005815 | AR | Primary |
Addresses
Primary practice location
2900 Medical Center Pkwy Ste 110
Bentonville, AR 72712-3212
Mailing address
2900 Medical Center Pkwy Ste 110
Bentonville, AR 72712-3212
Phone (479) 715-4262
Other practice location 1
3005 Highland Pkwy
Downers Grove, IL 60515-5682
Phone (877) 751-5783
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R095301 | AR | MD | Critical Care Medicine Registered Nurse |
Interoperability endpoints
- jade.vinson.1@18804.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552262400000",
"number": "1225520356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 MEDICAL CENTER PKWY STE 110",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727123212",
"telephone_number": "479-715-4262",
"fax_number": "866-817-7601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 MEDICAL CENTER PKWY STE 110",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727123212",
"telephone_number": "479-715-4262",
"fax_number": "866-817-7601"
}
],
"practiceLocations": [
{
"address_1": "3005 Highland Pkwy",
"address_purpose": "LOCATION",
"city": "Downers Grove",
"state": "IL",
"postal_code": "605155682",
"country_code": "US",
"telephone_number": "877-751-5783",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VINSON",
"first_name": "JADE",
"middle_name": "LEIGH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-04",
"last_updated": "2019-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "AR",
"license": "R095301",
"primary": false
},
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "AR",
"license": "A005815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; 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.