Individual
KATHY VANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ECDS
Contact information
Practice address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209-4840
(501) 562-5400
Mailing address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209-4840
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
AR
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
373H00000X
ECDS
—
05
—
373H00000X
—
AR
Enumeration date
10/17/2017
Last updated
10/17/2017
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