MEDICARE: NICOLE LEA YODER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	226258	AR

General Provider Information

NPI Number	:	1639989304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LEA YODER NP

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	501-362-0500
Fax Number	:	501-362-0501

Provider Business Practice Location Address
First Line	:	1800 BYPASS RD
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-9135
Country	:	US
Telephone Number	:	501-362-0500
Fax Number	:	501-362-0501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/24/2025

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