Healthcare Provider Details

I. General information

NPI: 1891622536
Provider Name (Legal Business Name): NICHOLE LEA USSERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MARY ELLEN DR
CONWAY AR
72034-9689
US

IV. Provider business mailing address

5 MARY ELLEN DR
CONWAY AR
72034-9689
US

V. Phone/Fax

Practice location:
  • Phone: 501-514-5885
  • Fax:
Mailing address:
  • Phone: 501-514-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR070627
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: