Provider Demographics
NPI:1174771091
Name:MAUPIN, FONDA KAY (MHPP)
Entity type:Individual
Prefix:
First Name:FONDA
Middle Name:KAY
Last Name:MAUPIN
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 2818
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2818
Mailing Address - Country:US
Mailing Address - Phone:417-350-0196
Mailing Address - Fax:501-203-0909
Practice Address - Street 1:727 HIGHWAY 62 E
Practice Address - Street 2:STE 4
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3209
Practice Address - Country:US
Practice Address - Phone:870-425-8642
Practice Address - Fax:870-425-8652
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174413795Medicaid