Basic Information
| Provider Information | |||||||||
| NPI: | 1629561808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISNEROS | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251420 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722251420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5015265148 | ||||||||
| Practice Location | |||||||||
| Address1: | 1617 N WASHINGTON | ||||||||
| Address2: | |||||||||
| City: | MAGNOLIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717532046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702347676 | ||||||||
| FaxNumber: | 8705622559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E-14391 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.