Provider Demographics
NPI:1689083537
Name:SMITH, NICHOLE (APRN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3183 STACY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7254
Mailing Address - Country:US
Mailing Address - Phone:501-424-7068
Mailing Address - Fax:
Practice Address - Street 1:11600 CHENAL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3707
Practice Address - Country:US
Practice Address - Phone:501-221-1160
Practice Address - Fax:501-221-1161
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213327163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse