Provider Demographics
NPI:1740840974
Name:VADEN, ALISHA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:DAWN
Last Name:VADEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-2221
Mailing Address - Country:US
Mailing Address - Phone:501-379-4246
Mailing Address - Fax:501-379-4248
Practice Address - Street 1:712 W 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2221
Practice Address - Country:US
Practice Address - Phone:501-379-4246
Practice Address - Fax:501-379-4248
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARL46136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health