Provider Demographics
NPI:1568899003
Name:ALEXANDER, TIFFANY (MHPP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ALEXANDER
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 1:1310 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2816
Mailing Address - Country:US
Mailing Address - Phone:479-498-4423
Mailing Address - Fax:479-498-4425
Practice Address - Street 1:1310 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2816
Practice Address - Country:US
Practice Address - Phone:479-498-4423
Practice Address - Fax:479-498-4425
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator