Provider Demographics
NPI:1407450539
Name:VAN HOUTEN, ALEXIS NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:NICOLE
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:757 SE FRONT STREET
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3025
Practice Address - Country:US
Practice Address - Phone:501-266-7265
Practice Address - Fax:501-266-7269
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR213369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily