Healthcare Provider Details

I. General information

NPI: 1477149847
Provider Name (Legal Business Name): BESSIE NICOLE THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W 12TH ST
LITTLE ROCK AR
72204-1513
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax:
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number125196
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number125196
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number125196
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: