1588933485 NPI number — MRS. JANETTA CROSS PARCHMAN MHPP

Table of content: MRS. JANETTA CROSS PARCHMAN MHPP (NPI 1588933485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588933485 NPI number — MRS. JANETTA CROSS PARCHMAN MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARCHMAN
Provider First Name:
JANETTA
Provider Middle Name:
CROSS
Provider Name Prefix Text:
MRS.
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:
1588933485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 CALVIN AVERY DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72301-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-732-1878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 FALLS BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNNE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72396-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-238-4014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2011

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

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





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