Provider Demographics
NPI:1619122181
Name:WITHAM, WILLIAM T (LPN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:WITHAM
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 AUTUMN RD
Mailing Address - Street 2:STE. 3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3704
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:
Practice Address - Street 1:1014 AUTUMN RD
Practice Address - Street 2:STE. 3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3704
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL43821171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator