Latasha Rena Van Heflin
Individual provider Active NPI Driver · Springdale, AR
NPI 1982205043 · NPPES record last updated Nov 5, 2020
Key facts
- NPI
- 1982205043
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 1268 Electric Ave
Springdale, AR 72764-7498 - Phone
- (870) 336-8100
- NPI assigned
- Nov 5, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Miracle Kids Success Academy Central | Current |
Accepting new patients |
Locations
3127 Southwest Dr
Jonesboro, AR 72404
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
1268 Electric Ave
Springdale, AR 72764-7498
Mailing address
3127 Southwest Dr
Jonesboro, AR 72404-8404
Phone (870) 336-8100
Other providers in Springdale, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.