Healthcare Provider Details

I. General information

NPI: 1588343529
Provider Name (Legal Business Name): NICOLE THERESE HARRELL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 SE I ST
BENTONVILLE AR
72712-3996
US

IV. Provider business mailing address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762-0845
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-5437
  • Fax: 479-273-9932
Mailing address:
  • Phone: 479-725-6801
  • Fax: 479-725-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number221973
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: