Healthcare Provider Details

I. General information

NPI: 1184949158
Provider Name (Legal Business Name): ANDREA MCDANIEL MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA ALLISON

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 FINCH RD
BISMARCK AR
71929-7541
US

IV. Provider business mailing address

3399 FINCH RD
BISMARCK AR
71929-7541
US

V. Phone/Fax

Practice location:
  • Phone: 501-865-3363
  • Fax: 501-865-3362
Mailing address:
  • Phone: 501-865-3363
  • Fax: 501-865-3362

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: