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NPI Code Detail

MEDICARE: TIFFANY WHITTEN

MEDICARE: TIFFANY WHITTEN
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
1171M00000XCase Manager/Care CoordinatorAR
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902288145
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY WHITTEN
Provider Business Mailing Address
First Line : 6210 BASELINE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-4728
Country : US
Telephone Number : 501-265-0302
Fax Number :
Provider Business Practice Location Address
First Line : 6210 BASELINE RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72209-4728
Country : US
Telephone Number : 501-265-0302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2015
Last Update Date : 04/15/2026

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Directions to “ TIFFANY WHITTEN ” Practice Location

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