Healthcare Provider Details

I. General information

NPI: 1225620149
Provider Name (Legal Business Name): KIZZIE DENISE HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 KANIS RD
LITTLE ROCK AR
72205-6414
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-2712
  • Fax:
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number214809
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: