1154564524 NPI number — TAMMIE LANETT ALLEN BS, MHPP

Table of content: TAMMIE LANETT ALLEN BS, MHPP (NPI 1154564524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154564524 NPI number — TAMMIE LANETT ALLEN BS, MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
TAMMIE
Provider Middle Name:
LANETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, MHPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
TAMMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MHPP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154564524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10025 W MARKHAM ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-663-5473
Provider Business Mailing Address Fax Number:
501-801-1816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10025 W MARKHAM ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-663-5473
Provider Business Practice Location Address Fax Number:
501-801-1816
Provider Enumeration Date:
04/14/2009

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 137548726 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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