Provider Demographics
NPI:1710017686
Name:MADDEN, HERVEY MAC (MD)
Entity Type:Individual
Prefix:
First Name:HERVEY
Middle Name:MAC
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GAP RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8679
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:870-793-8959
Practice Address - Street 1:3302 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4886
Practice Address - Country:US
Practice Address - Phone:501-268-4181
Practice Address - Fax:501-268-5301
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018032451103TC2200X
OK34192103TC2200X
SC270242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent