Provider Demographics
NPI:1790365427
Name:AMINI, ARIANNA NEKKA
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:NEKKA
Last Name:AMINI
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 1:2415 PRINCE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3718
Mailing Address - Country:US
Mailing Address - Phone:901-692-8371
Mailing Address - Fax:
Practice Address - Street 1:2415 PRINCE ST STE 100
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3718
Practice Address - Country:US
Practice Address - Phone:901-692-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
AR4563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program