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NPI Code Detail

MEDICARE: PATRENA D TABRON B.A, M.H.P.P.

MEDICARE: PATRENA D TABRON B.A, M.H.P.P.
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 CounselorA1603032AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750590733
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRENA D TABRON B.A, M.H.P.P.
Provider Business Mailing Address
First Line : 6800 MABELVALE CUT OFF
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-2370
Country : US
Telephone Number : 501-837-3728
Fax Number :
Provider Business Practice Location Address
First Line : 4400 SHUFFIELD DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7100
Country : US
Telephone Number : 501-686-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 04/05/2016

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