Provider Demographics
NPI:1588343529
Name:HARRELL, NICOLE THERESE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RETTENDON LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3225
Mailing Address - Country:US
Mailing Address - Phone:860-983-9665
Mailing Address - Fax:
Practice Address - Street 1:2719 SE I ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3996
Practice Address - Country:US
Practice Address - Phone:479-273-5437
Practice Address - Fax:479-273-9932
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221973363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics