Provider Demographics
NPI:1043899503
Name:LITTLE, JESSIE (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2911
Mailing Address - Country:US
Mailing Address - Phone:870-414-4000
Mailing Address - Fax:
Practice Address - Street 1:1401 HWY 65 NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-414-4022
Practice Address - Fax:870-414-2023
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-17273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics