Lange-Halley, Jacquelyn Rae

Lange-Halley, Jacquelyn Rae is an individual health care provider with primary practice located at 2580 E Joyce Blvd Ste 1 , Fayetteville AR 72703-3924. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Lange-Halley, Jacquelyn Rae can be contacted via phone (479) 305-7201.

Contact Information

Primary practice address
2580 E Joyce Blvd Ste 1 Fayetteville AR 72703-3924
Phone: (479) 305-7201
Fax: (949) 577-4833
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X E-9197 Arkansas

Profile Details

NPI number 1699065110
LBN Legal business name Lange-Halley, Jacquelyn Rae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2011
Last updated Oct 18th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699065110 NPPES
Arkansas MEDICAID 211861001

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