Healthcare Provider Details

I. General information

NPI: 1568565521
Provider Name (Legal Business Name): TARA CAYE HERNANDEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 STOCKTON DR
NORTH LITTLE ROCK AR
72117-2917
US

IV. Provider business mailing address

PO BOX 15968
LITTLE ROCK AR
72231-5968
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-7600
  • Fax: 501-955-7612
Mailing address:
  • Phone: 501-221-1843
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1823-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2282-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: