Healthcare Provider Details

I. General information

NPI: 1902571151
Provider Name (Legal Business Name): NAKIA ALEXANDRIA BRIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SMOKEY LN
NORTH LITTLE ROCK AR
72117-2506
US

IV. Provider business mailing address

250 SMOKEY LN
NORTH LITTLE ROCK AR
72117-2506
US

V. Phone/Fax

Practice location:
  • Phone: 501-503-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2301002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: