Provider Demographics
NPI:1487308177
Name:NIZZA, AMY JENKINS
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JENKINS
Last Name:NIZZA
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 1:2314 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2153
Mailing Address - Country:US
Mailing Address - Phone:479-619-8313
Mailing Address - Fax:
Practice Address - Street 1:3680 N INVESTMENT DR STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5458
Practice Address - Country:US
Practice Address - Phone:479-435-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2105012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health