Healthcare Provider Details

I. General information

NPI: 1679488217
Provider Name (Legal Business Name): NICKIE SANTANNA CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 AR-27
HECTOR AR
72843
US

IV. Provider business mailing address

32 MCCOY CREEK DR
DOVER AR
72837-5034
US

V. Phone/Fax

Practice location:
  • Phone: 479-284-2213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number227164
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: