Provider Demographics
NPI:1841485893
Name:HAYES, MAHALA KATHERINE (MHPP)
Entity type:Individual
Prefix:MRS
First Name:MAHALA
Middle Name:KATHERINE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250337
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-0337
Mailing Address - Country:US
Mailing Address - Phone:501-686-9318
Mailing Address - Fax:501-686-9618
Practice Address - Street 1:4400 SHUFFIELD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7100
Practice Address - Country:US
Practice Address - Phone:501-686-9318
Practice Address - Fax:501-686-9618
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
177F00000X
AR3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No177F00000XOther Service ProvidersLodging