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NPI Code Detail

MEDICARE: MS. MISTI L. PREWETT L.A.C.

MEDICARE: MS. MISTI L. PREWETT L.A.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA0303026AR

General Provider Information

NPI Number : 1750356739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MISTI L. PREWETT L.A.C.
Provider Business Mailing Address
First Line : PO BOX 6399
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71902-6399
Country : US
Telephone Number : 501-332-5236
Fax Number : 501-332-8534
Provider Business Practice Location Address
First Line : 1615 MARTIN LUTHER KING BLVD
Second Line :
City : MALVERN
State : AR
Zip : 72104-2233
Country : US
Telephone Number : 501-332-5236
Fax Number : 501-332-8534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/08/2007

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