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General NPI Number Information
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NPI Number | 1154610111
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Entity Type | Individual
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Provider Name | ESSIE L HEWETT TARGETED CASE MANAGE
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 6311 WEST 83RD STREET SUITE B
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City | LITTLE ROCK
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State | AR
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Zip | 72214
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Country | US
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Telephone | 501-562-2788
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Fax | 501-562-2784
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Provider Business Mailing Address
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Address Line | 6311 WEST 63RD
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City | LITTLE ROCK
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State | AR
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Zip | 72209
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Country | US
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Telephone | 501-562-2788
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Fax | 501-562-2784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 121985746
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 140168763
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License Number State |
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