1841485893 NPI number — MRS. MAHALA KATHERINE HAYES MHPP

Table of content: MRS. MAHALA KATHERINE HAYES MHPP (NPI 1841485893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841485893 NPI number — MRS. MAHALA KATHERINE HAYES MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYES
Provider First Name:
MAHALA
Provider Middle Name:
KATHERINE
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:
1841485893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250337
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:
72225-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-686-9318
Provider Business Mailing Address Fax Number:
501-686-9618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 SHUFFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-7100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-686-9318
Provider Business Practice Location Address Fax Number:
501-686-9618
Provider Enumeration Date:
09/12/2007

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: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X , 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)





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