Provider Demographics
NPI:1225472798
Name:SIKOLE, THERESA M (ARNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SIKOLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4817
Mailing Address - Country:US
Mailing Address - Phone:870-367-1373
Mailing Address - Fax:
Practice Address - Street 1:4747 DUSTY LAKE DR STE 101
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9057
Practice Address - Country:US
Practice Address - Phone:870-541-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner