Provider Demographics
NPI:1679073696
Name:MUMFORD, QUINYATTA PATISE (DRPH, MPH, CHES)
Entity type:Individual
Prefix:DR
First Name:QUINYATTA
Middle Name:PATISE
Last Name:MUMFORD
Suffix:
Gender:F
Credentials:DRPH, MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JORDAN MNR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7902
Mailing Address - Country:US
Mailing Address - Phone:256-648-3301
Mailing Address - Fax:
Practice Address - Street 1:8 JORDAN MNR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7902
Practice Address - Country:US
Practice Address - Phone:501-229-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17939174H00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach