Basic Information
Provider Information
NPI: 1003293556
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HESINGTON
FirstName: AIRITY
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KNOTTS
OtherFirstName: AIRITY
OtherMiddleName: C
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 2400 S 48TH ST
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 727626683
CountryCode: US
TelephoneNumber: (479) 750-2020
FaxNumber: 4797504843
Practice Location
Address1: 60 W SUNBRIDGE DR
Address2:  
City: FAYETTEVILLE
State: AR
PostalCode: 727031822
CountryCode: US
TelephoneNumber: 4796951240
FaxNumber: 4797504843
Other Information
ProviderEnumerationDate: 05/05/2015
LastUpdateDate: 12/01/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X8354-MARY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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