Provider Demographics
NPI:1477231637
Name:NICHOLSON, ANNA LEIGH
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEIGH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
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 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-208-8362
Mailing Address - Fax:870-208-8384
Practice Address - Street 1:206 LAKE STREET
Practice Address - Street 2:
Practice Address - City:PARKIN
Practice Address - State:AR
Practice Address - Zip Code:72373
Practice Address - Country:US
Practice Address - Phone:870-755-2737
Practice Address - Fax:870-551-3724
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist