Provider Demographics
NPI:1083904718
Name:HUEY, DEIDRE PAIGE (COTA)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:PAIGE
Last Name:HUEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:PAIGE
Other - Last Name:HAMMETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:140 HEIFER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72157-9658
Mailing Address - Country:US
Mailing Address - Phone:501-354-1052
Mailing Address - Fax:
Practice Address - Street 1:711 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5120
Practice Address - Country:US
Practice Address - Phone:601-605-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA6102083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine