Provider Demographics
NPI:1386203321
Name:HOUTCHENS, JEREMY HEATH (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:HEATH
Last Name:HOUTCHENS
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5921
Mailing Address - Country:US
Mailing Address - Phone:479-787-8933
Mailing Address - Fax:
Practice Address - Street 1:12911 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1701
Practice Address - Country:US
Practice Address - Phone:501-224-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty