Healthcare Provider Details

I. General information

NPI: 1457683161
Provider Name (Legal Business Name): MARILYN GAY DUFF MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1505 S OLD MISSOURI RD
SPRINGDALE AR
72764-1158
US

IV. Provider business mailing address

1014 AUTUMN RD SUITE 4
LITTLE ROCK AR
72211-3704
US

V. Phone/Fax

Practice location:
  • Phone: 479-756-1460
  • Fax: 479-756-1464
Mailing address:
  • Phone: 501-221-1941
  • Fax: 501-221-1553

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: