Healthcare Provider Details

I. General information

NPI: 1518649227
Provider Name (Legal Business Name): RAEGAN LEA HUFFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 GRAHAM ST
MOUNTAINBURG AR
72946-4107
US

IV. Provider business mailing address

809 GRAHAM ST
MOUNTAINBURG AR
72946-4107
US

V. Phone/Fax

Practice location:
  • Phone: 479-806-3187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: