Provider Demographics
NPI:1073893996
Name:PARKHURST, TIFFANY DAWN (MHPP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 N GREGG AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5543
Mailing Address - Country:US
Mailing Address - Phone:479-582-5565
Mailing Address - Fax:
Practice Address - Street 1:2592 N GREGG AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5543
Practice Address - Country:US
Practice Address - Phone:479-582-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator