Provider Demographics
NPI:1164047437
Name:WARREN, RHIANNA (BS)
Entity Type:Individual
Prefix:
First Name:RHIANNA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NAPA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5007
Mailing Address - Country:US
Mailing Address - Phone:501-265-0302
Mailing Address - Fax:501-265-0300
Practice Address - Street 1:6210 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4728
Practice Address - Country:US
Practice Address - Phone:501-265-0302
Practice Address - Fax:501-265-0300
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236900526Medicaid