Edith Fava

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP#3282 Issued in AR

Practice address

1659 S Highway 65 82
Lake Village, AR 71653-1661

Phone

(870) 265-4191

NPI assigned

Oct 8, 2015

Last updated

Sep 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• TLC Early Learning and Play Center

  • Early Intervention Provider Agency
  • Lake Village, AR
  • NPI 1326460254
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1477924041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1052",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387021052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1659 S HIGHWAY 65 82",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716531661",
            "telephone_number": "870-265-4191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAVA",
        "first_name": "EDITH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-08",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "SP#3282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina E Deal, FNP-C
• Laniece Edwards
• Misty Kaye Ellerbe, OT
• Emergency Ambulance Service of Arkansas, Inc.
• Kelli Jean Fairris, M.S.E., L.P.C
• Douglas Errol Fleming II, PT
• Laura Brooke Flemister-Smith
• Tiffany Denise Fox, OT-A
• David Bruce French, PHARM.D.
• Whitney Gayfield

• Speech-Language Pathologist in Lake Village, AR
• Providers in Lake Village, AR by specialty
• Speech-Language Pathologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.