Healthcare Provider Details

I. General information

NPI: 1902125560
Provider Name (Legal Business Name): MS. MONIQUE BATTLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9914 I -30 FRONTAGE RD
LITTLE ROCK AR
72209-4859
US

IV. Provider business mailing address

9914 I-30 FRONTAGE RD
LITTLE ROCK AR
72209
US

V. Phone/Fax

Practice location:
  • Phone: 501-265-0302
  • Fax: 501-265-0300
Mailing address:
  • Phone: 501-265-0302
  • Fax: 501-265-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: