Healthcare Provider Details

I. General information

NPI: 1558313502
Provider Name (Legal Business Name): JOHN R LITTLETON P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6587 MAMALAHOA HIGHWAY SUITE C-201
KEALAKEKUA HI
96750
US

IV. Provider business mailing address

PO BOX 2060
KEALAKEKUA HI
96750-2060
US

V. Phone/Fax

Practice location:
  • Phone: 808-323-3107
  • Fax: 808-323-0012
Mailing address:
  • Phone: 808-323-3107
  • Fax: 808-323-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-415
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: