1033326004 NPI number — MS. SHIQUITA FONTAE HOUFF MHPP

Table of content: MS. SHIQUITA FONTAE HOUFF MHPP (NPI 1033326004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033326004 NPI number — MS. SHIQUITA FONTAE HOUFF MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUFF
Provider First Name:
SHIQUITA
Provider Middle Name:
FONTAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MHPP
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:
1033326004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3214 WINCHESTER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-326-6160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 S RODNEY PARHAM RD
Provider Second Line Business Practice Location Address:
APT. 25E
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-4881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-353-2620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

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: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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