Provider Demographics
NPI:1487194346
Name:NICHOLS, RENETTA RUTH (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RENETTA
Middle Name:RUTH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 BUTTERFIELD COACH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9142
Mailing Address - Country:US
Mailing Address - Phone:479-757-5026
Mailing Address - Fax:479-757-5028
Practice Address - Street 1:2158 BUTTERFIELD COACH RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-9142
Practice Address - Country:US
Practice Address - Phone:479-757-5026
Practice Address - Fax:479-757-5028
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR005058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily