Healthcare Provider Details

I. General information

NPI: 1164879417
Provider Name (Legal Business Name): NIKIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 MERRILL DR
LITTLE ROCK AR
72212-4009
US

IV. Provider business mailing address

1719 MERRILL DR
LITTLE ROCK AR
72212-4009
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7929C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: