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Individual

MRS. JANA RENEE NICHOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR /L

Contact information

Practice address
11327 GIBB WHITMIRE RD, PRAIRIE GROVE, AR 72753-8107
(479) 422-2876
(479) 846-5347
Mailing address
11327 GIBB WHITMIRE RD, PRAIRIE GROVE, AR 72753-8107
(479) 422-2876
(479) 846-5347

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR542
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
130801721
AR
01
5T561
BCBS
AR
Enumeration date
08/14/2006
Last updated
04/15/2009
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