Provider Demographics
NPI:1689304719
Name:MANIS, MONICA RENAEE (QBHP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENAEE
Last Name:MANIS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RENAEE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:187-093-3688
Mailing Address - Fax:
Practice Address - Street 1:1101 W MORGAN ST STE 8
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2848
Practice Address - Country:US
Practice Address - Phone:870-335-9483
Practice Address - Fax:870-335-9487
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator