Healthcare Provider Details

I. General information

NPI: 1801014659
Provider Name (Legal Business Name): SUZANNE NICHOLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

IV. Provider business mailing address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-4451
  • Fax:
Mailing address:
  • Phone: 479-575-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-9434
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: