Healthcare Provider Details

I. General information

NPI: 1902719552
Provider Name (Legal Business Name): BAILEY NICHOLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 HIGHWAY 62 412
HIGHLAND AR
72542-9497
US

IV. Provider business mailing address

306 E MAIN ST
ASH FLAT AR
72513-8008
US

V. Phone/Fax

Practice location:
  • Phone: 870-955-1020
  • Fax: 870-277-0896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA2243
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: