Healthcare Provider Details

I. General information

NPI: 1013397116
Provider Name (Legal Business Name): PAIGE HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S MAIN ST
BERRYVILLE AR
72616-4330
US

IV. Provider business mailing address

32 HOLIDAY ISLAND DR
HOLIDAY ISLAND AR
72631-5305
US

V. Phone/Fax

Practice location:
  • Phone: 870-423-1077
  • Fax:
Mailing address:
  • Phone: 479-244-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: