1154610111 NPI number — MS. ESSIE L HEWETT TARGETED CASE MANAGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154610111 NPI number — MS. ESSIE L HEWETT TARGETED CASE MANAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEWETT
Provider First Name:
ESSIE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
TARGETED CASE MANAGE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154610111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6311 WEST 63RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-562-2788
Provider Business Mailing Address Fax Number:
501-562-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6311 WEST 83RD STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-562-2788
Provider Business Practice Location Address Fax Number:
501-562-2784
Provider Enumeration Date:
03/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  121985746 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X , with the licence number: 140168763 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140168763 . This is a "GROUP TARGETED CASE MANAGER NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 121985746 . This is a "TARGETED CASE MANAGER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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