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General NPI Number Information
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NPI Number | 1386203321
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Entity Type | Individual
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Provider Name | JEREMY HEATH HOUTCHENS MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 12911 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223-1701
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Country | US
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Telephone | 501-224-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 55 W POINT DR
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City | MAUMELLE
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State | AR
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Zip | 72113-5921
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Country | US
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Telephone | 479-787-8933
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 120486
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License Number State | AR
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