Basic Information
| Provider Information | |||||||||
| NPI: | 1407450539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN HOUTEN | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018127800 | ||||||||
| FaxNumber: | 5018127207 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 SE FRONT STREET | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720863025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012667265 | ||||||||
| FaxNumber: | 5012667269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2020 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 213369 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.