Individual
DR. SCOTT RICHARD NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 CAMDEN RD # 22, PINE BLUFF, AR 71603-4612
(870) 879-3517
(870) 879-6049
Mailing address
3801 CAMDEN RD # 22, PINE BLUFF, AR 71603-4612
(870) 879-3517
(870) 879-6049
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C6461
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110603001
—
AR
01
—
13838000000
QUALCHOICE OF ARKANSAS
AR
01
—
4535270
AETNA
—
Enumeration date
06/16/2006
Last updated
11/13/2015
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