Provider Demographics
NPI:1407214448
Name:NICHOLS, ANGELA (MHPP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NICHOLS
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 1:1303 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6706
Mailing Address - Country:US
Mailing Address - Phone:501-745-4448
Mailing Address - Fax:501-748-8826
Practice Address - Street 1:1303 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6706
Practice Address - Country:US
Practice Address - Phone:501-745-4448
Practice Address - Fax:501-748-8826
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator