=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447370911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JOE D. LITTLETON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9160 CHILDRESS RD
-----------------------------------------------------
City | WEST PADUCAH
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42086-9508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-443-3917
-----------------------------------------------------
Fax | 270-415-9881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9160 CHILDRESS RD
-----------------------------------------------------
City | WEST PADUCAH
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42086-9508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-443-3917
-----------------------------------------------------
Fax | 270-415-9881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------