Provider Demographics
NPI:1982856001
Name:BOSTON, KISHA (MSW, MHPP)
Entity Type:Individual
Prefix:MS
First Name:KISHA
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:MSW, MHPP
Other - Prefix:MS
Other - First Name:KISHA
Other - Middle Name:
Other - Last Name:BOSTON-MAYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAME
Mailing Address - Street 1:801 S RODNEY PARHAM RD
Mailing Address - Street 2:APT 26A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4881
Mailing Address - Country:US
Mailing Address - Phone:501-217-9559
Mailing Address - Fax:
Practice Address - Street 1:1900 PINE ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2401
Practice Address - Country:US
Practice Address - Phone:501-771-8261
Practice Address - Fax:501-771-8263
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator