Provider Demographics
NPI:1013220334
Name:MATHIS, KEITHEN ALEX (MHPP)
Entity Type:Individual
Prefix:MR
First Name:KEITHEN
Middle Name:ALEX
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MHPP
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Other - Credentials:
Mailing Address - Street 1:4700 W COMMERCIAL DR
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7068
Mailing Address - Country:US
Mailing Address - Phone:501-753-8400
Mailing Address - Fax:501-753-8401
Practice Address - Street 1:4700 W COMMERCIAL DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7068
Practice Address - Country:US
Practice Address - Phone:501-753-8400
Practice Address - Fax:501-753-8401
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator