1811003742 NPI number — DR. RHONDA LAURENE TANNEHILL PHD

Table of content: DR. RHONDA LAURENE TANNEHILL PHD (NPI 1811003742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811003742 NPI number — DR. RHONDA LAURENE TANNEHILL PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANNEHILL
Provider First Name:
RHONDA
Provider Middle Name:
LAURENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1811003742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 734
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT IDA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71957-0734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-356-5718
Provider Business Mailing Address Fax Number:
870-356-5719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2268 HIGHWAY 8 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71960-8508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-356-5718
Provider Business Practice Location Address Fax Number:
870-356-5719
Provider Enumeration Date:
08/22/2006

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: 103T00000X , with the licence number:  98-10P , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 227176719 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710831320 . This is a "PPO PLUS ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 137-635 . This is a "MHS NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 72099 . This is a "AMERICAN LIFE PAYRO ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 184725 . This is a "MANAGED HEALTH NETWORK ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 710831320 . This is a "TRICARE PROVIDER NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 61-74982 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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