Healthcare Provider Details

I. General information

NPI: 1285568683
Provider Name (Legal Business Name): NICHOLLE DORN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S ROGERS ST STE E
CLARKSVILLE AR
72830-4331
US

IV. Provider business mailing address

910 S ROGERS ST STE E
CLARKSVILLE AR
72830-4331
US

V. Phone/Fax

Practice location:
  • Phone: 479-335-5747
  • Fax: 479-957-9083
Mailing address:
  • Phone: 479-335-5747
  • Fax: 479-957-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICHOLLE DORN
Title or Position: LCSW
Credential: LCSW
Phone: 479-264-5833