Healthcare Provider Details

I. General information

NPI: 1346587599
Provider Name (Legal Business Name): MARANDA ELIZABETH NICHOLS PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 E HIGHLAND DR STE A
JONESBORO AR
72401-6621
US

IV. Provider business mailing address

4334 E HIGHLAND DR STE A
JONESBORO AR
72401-6621
US

V. Phone/Fax

Practice location:
  • Phone: 870-802-0012
  • Fax: 870-972-5140
Mailing address:
  • Phone: 870-802-0012
  • Fax: 870-972-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: