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General NPI Number Information
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NPI Number | 1184197501
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Entity Type | Individual
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Provider Name | NIKITA NI'COLE COLEMAN-SMITH AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 900 N 7TH ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-2001
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Country | US
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Telephone | 870-735-3842
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N 7TH ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-2001
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Country | US
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Telephone | 870-735-3842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | A006029
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | PMH12240005
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | A006029
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License Number State | AR
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