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General NPI Number Information
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NPI Number | 1225833411
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Entity Type | Organization
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Legal Business Name | DEDRA JAI HUE LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 10515 W MARKHAM ST STE I3
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2283
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Country | US
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Telephone | 501-492-6797
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Fax | 501-307-1259
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Provider Business Mailing Address
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Address Line | 10515 W MARKHAM ST STE I3
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2283
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Country | US
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Telephone | 501-492-6797
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Fax | 501-307-1259
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Authorized Official
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Title or Position | CEO
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Name | MRS. LADEIDRA DONAHUE
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Credential | NRCMA, NRCPT
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Telephone | 501-492-6797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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